Preamble

The House met at half-past Two o'clock

PRAYERS

[MADAM SPEAKER in the Chair]

Oral Answers to Questions — EDUCATION

Funding Agency for Schools

Mr. Key: To ask the Secretary of State for Education if he will make a statement about the relationship between the Funding Agency for Schools and local education authorities. [19168]

The Parliamentary Under-Secretary of State for Schools (Mr. Robin Squire): The Funding Agency for Schools now has shared or sole planning responsibility for the supply of school places in 50 local education authorities. It also has regular contact with LEAs about the funding of grant-maintained schools. In my experience, those relationships are generally constructive.

Mr. Key: Is my hon. Friend aware that Liberal Democrat-controlled Wiltshire county council told his Department that it had a clear mandate and the agreement of heads to take money out of school budgets when neither of those claims was true? Does the FAS have powers to investigate such deception?

Mr. Squire: I know that my hon. Friend has corresponded with the FAS about this matter. I understand that the GM schools were initially consulted about the proposal to which he refers but that they did not respond as a result of a misunderstanding about the document that they were sent. From the evidence that I have so far received, it does not appear that the LEA intended any deception. In the event, as my hon. Friend knows, the proposal to which the GM schools eventually took great exception was at variance with the policy of my right hon. Friend the Secretary of State. It was accordingly modified by her before it was approved, and a ceiling of 0.5 per cent. was imposed on the percentage of the general schools budget.

Mr. Dafis: As the grant-maintained schools movement in Wales has run entirely into the sand, despite the constraints on local education funding and the enticements to schools to become grant-maintained, does the Minister agree that there is now no reason to establish a schools funding agency for Wales?

Mr. Squire: The hon. Gentleman knows better than to tempt me down the highways and byways of the Principality. However, if the energy of my right hon. Friend the Secretary of State for Wales is as great as I know it is from having worked with him I am sure that

he will draw inspiration from, for instance, the fact that, last month alone, eight out of 10 ballots in England resulted in a yes vote to become grant-maintained.

Mr. Kilfoyle: I know that it is extremely difficult to obtain a straight answer to a straight question from the Government on education, but the relationship between LEAs and the FAS depends on the number of grant-maintained schools in a given part of the country.
Given all the Government splits—on nursery education or on funding—will the Minister give a straight answer to the rumours that are circulating in Conservative newspapers that the Government intend to make grant-maintained status compulsory for all schools after the next general election: yes or no?

Mr. Squire: The whole House enjoyed that one. The answer to the hon. Gentleman's question is, as he has been told many times from the Dispatch Box, that we have no plans to make such a change.
I could not let slip the small side comment that the House heard—something to the effect that the Government were split on education. I say only that, if all Opposition Members who had enjoyed a privileged education, who had sent their children to a privileged education or who simply enjoyed the benefits of grant-maintained status had instructed their councillors and activists throughout the country not to campaign so hard against GM status, the figures would be even better than those that I gave to the hon. Member for Ceredigion and Pembroke, North (Mr. Dafis) a moment ago.

Mr. Harry Greenway: Does my hon. Friend agree that teachers who behave like yobboes and hooligans in public, whether they are employed by GM schools or local authority schools, are likely to be unsatisfactory in professional terms? From experience, I know that often they are the people who do least in the classroom and elsewhere in the school.
Will my hon. Friend give the House and the country a guarantee that people who behave unsatisfactorily in professional terms in schools will be properly disciplined, however they behave in public?

Mr. Squire: As my hon. Friend knows from his wide experience, those are matters for governing bodies. I doubt whether many governors across the country would have been other than appalled at some of the scenes at the National Union of Teachers' conference, which did no service to the union. There is no place in the classroom for politics; what teachers do in their spare time must be a matter for them. The incident did not assist in the projection of teaching as the honourable and proper profession that we know it to be.

Teachers' Pay and Conditions

Ms Quin: To ask the Secretary of State for Education when she last met teachers or their representatives to discuss pay and conditions; and if she will make a statement. [19169]

The Secretary of State for Education (Mrs. Gillian Shephard): I discussed pay and conditions with representatives of each of the main professional teacher


associations at meetings held in March. At the end of March, I announced my acceptance of the independent review body's recommendations.

Ms Quin: Does the Secretary of State realise that vague promises about possible jam tomorrow are simply not good enough and that parental support for teachers and for a better education service remains strong? What will she do, here and now, to tackle the problems of class sizes and to ensure that the teachers' pay award is fully and properly funded?

Mrs. Shephard: Each year local authorities say that funding is insufficient. The settlement is manageable, although it is tough and has a variable impact across the country. The vast majority of local authorities have managed to fund the teachers' pay award in full, many of which are funding other aspects of education in addition. There is no accumulated evidence to link class size with attainment. Class sizes have edged up over the past couple of years and, I am glad to say, standards have risen a great deal.

Mr. Peter Atkinson: Is my right lion. Friend aware that Northumberland county council has cut £800,000 from its schools budget amid a well-orchestrated campaign to convince parents that it is the Government's fault? Does he realise that the county council decided, at the same time, to spend £700,000 a year funding road races? Furthermore, a few days ago it decided to award county councillors higher allowances—it will spend a further £400,000 a year on allowances, including a 260 per cent. increase in the basic allowance. Does that not show that Labour local authorities are more concerned with propaganda than with educating children?

Mrs. Shephard: It seems extraordinary that a local authority should place greater emphasis on councillors' allowances than on spending in the classroom. That merely goes to prove what we have been saying all along—that the vast majority of authorities are able to identify their priorities and protect front-line services. What a pity it is that Northumberland is not prepared to do so.

Dr. Marek: In the light of the right hon. Lady's statement about class sizes, will she tell us why class sizes in public schools are much lower than in state schools?

Mrs. Shephard: I find it difficult to understand why Opposition Members so frequently raise the subject of independent education. I should have thought that they might be embarrassed that so many of their colleagues are in the awkward position of wanting to exercise choice for their own children while opposing it for other people's. Conservatives have no such difficulty: we believe in choice, diversity and excellence, and we have the added advantage of practising what we preach.

Mr. Pawsey: Does my right hon. Friend agree that the overwhelming majority of the nation's teachers are dedicated to their profession and to the children in their charge? Will he therefore make it clear to teachers that those who argue the case for selective strikes or who seek to introduce a rota under which children are sent home will damage not just the children's education but teachers' standing in the eyes of parents?

Mrs. Shephard: Yes, industrial action by teachers, whatever form it takes, can only damage children,

children's education and our schools. It will certainly infuriate parents and it will yet again harm teachers' professional reputations, which had begun to recover after the regrettable industrial action of the mid-1980s.

Teaching Posts

Mr. Ainger: To ask the Secretary of State for Education what estimate she has made of the number of teachers' posts that will be cut in the current financial year. [19170]

Mr. Robin Squire: My right hon. Friend has not made any such estimates.

Mr. Ainger: I am extremely surprised by that answer because in a letter to the Chancellor of the Duchy of Lancaster the Secretary of State for Education predicted that a teachers' pay award of between 2 and 3 per cent. would be the resource equivalent of the loss of between 7,000 and 10,000 jobs. She went on to say that that would mean a tightening of pupil-teacher ratios and, to use her words, class sizes would "shoot up". Was she right then, or is the recent research published by the University of Manchester in The Times Educational Supplement, which predicted teacher job losses of 14,000 this year, more accurate?

Mr. Squire: As the hon. Gentleman knows, Ministers have never commented and will never comment on allegedly leaked documents.
On the substance of the hon. Gentleman's question, on reflection he will understand why, with decisions lying with some 109 local education authorities—some of which, certainly the Conservative-controlled ones, have sought to protect and enhance education while others have not done so—there is a wide variation in any such prediction. When one includes in that equation the 24,000 separate governing bodies, it is obvious that making predictions will be difficult.
The hon. Gentleman will bear in mind the fact that the Manchester university survey was conducted in January and February, before any school knew what its budget would be for the forthcoming year. If one invites people to assume the worst from a position of temporary ignorance, they will no doubt do so.

Dame Elaine Kellett-Bowman: Is the Minister aware that 776 schools in Lancashire employ 12,300 teachers to educate 217,000 children? That gives a ratio of 17.64:1, yet when a constituent of mine rang county hall and asked how many teachers were teaching classes of over 30 he was told that three quarters were doing so. He then commented acidly to county hall that that means that between 3,000 and 5,000 teachers are doing absolutely nothing at all.

Mr. Squire: Not for the first time, my hon. Friend has put her finger on a very important point. The whole House, and certainly I as a Minister, awaits with interest the next instalment, when we shall hear Lancashire education authority's explanation for that astounding disparity.

Mr. Don Foster: Does the Minister personally believe that over the next 12 months teaching posts will be axed and class sizes will rise, and does he believe that rather than attacking local government bureaucracy it would be more appropriate to look at central Government


bureaucracy in education? Does he acknowledge that there has been a significant increase in the administrative costs of quangos from £3 million to £98 million and a significant increase in the cost of departmental publications? Does he accept that, with all that going on, central DFE administrative expenditure has also risen?

Mr. Squire: There was a lot of fluff in that question. I am not sure what it adds up to, but I agree that it is correct for Government to look to control their administration, which we certainly do and will continue to do. The hon. Gentleman glosses over not a few Liberal Democrat councils that have deliberately chosen to maintain staffing at county hall or town hall and put teachers' jobs at risk. As for predictions about teachers, I can only say to the hon. Member that over a year ago we heard similar stories about chaos and calamity, yet the net result has been that 1,000 extra teachers have been employed.

Further and Higher Education

Mr. Fabricant: To ask the Secretary of State for Education what plans she has to broaden the education base for sixth formers, and others, currently taking A-levels for entry to university; and if she will make a statement. [19171]

Mrs. Gillian Shephard: I have asked Sir Ron Dearing to review the qualifications framework to see whether there is scope to achieve greater coherence and breadth of study post-16 without compromising standards.

Mr. Fabricant: I am grateful to my right hon. Friend for that reply. With one in three students going into further and higher education, which is a huge contrast to the appalling record of the Opposition under whom fewer than one in eight did so, does my right hon. Friend agree that we need a broader-based curriculum for those studying for A-level and planning to enter university? Does she agree that we need more articulate engineers and more numerate arts graduates and—dare I say it?—Members of Parliament?

Mrs. Shephard: I expect that my hon. Friend will dare to say it. I know that he has taken a particular interest in the range of courses available to 16 to 19-year-olds. The new qualifications framework offers the opportunity to mix and match qualifications—A-levels, AS levels, general national vocational qualifications and so on—so that learning programmes can be suited to individual needs. However, we want Sir Ron Dearing to advise on what more we can do to extend the benefits of that framework to make it easier for young people to mix and match so that they will satisfy the needs of admission tutors and employers or be fitted for further training, but, of course, always without compromising standards.

Mr. Gunnell: What study has the Secretary of State made of the international baccalaureate, especially two aspects of it that relate directly to this question—the fact that more subjects are studied and that studies are undertaken at two different academic levels, with half the subjects being taken at a higher level than the other half?

Mrs. Shephard: I am aware of the nature of the international baccalaureate and of its popularity in certain quarters. There are those who say that the standard A-level course is too narrow but, of course, it is open to young people to enhance A-levels with AS levels or

GNVQs. We want Sir Ron to look at ways to extend the benefits of mixing qualifications. I am sure that he will take into account the lessons of the baccalaureate, and I dare say that the hon. Gentleman will draw its advantages to Sir Ron's attention, which he is most welcome to do.

Mr. Jenkin: Is my right hon. Friend aware of some public concern that public examinations are not as rigorous as they used to be? What assurance can she give that not only will the A-level remain the gold standard in the education system but that other public examinations, especially GCSEs, will be toughened to ensure that people are tested on what they should be tested on and that we are not aiming simply for large numbers of examination passes?

Mrs. Shephard: Perhaps I could reassure my hon. Friend immediately. We certainly have no intention of scrapping A-levels. GCSE A-level standards are of paramount importance and have to be protected. A-levels have been tried and tested and are internationally respected, but a number of questions have to be tackled in Sir Ron's review. One is the 26 per cent. drop-out rate among A-level students. Clearly, that must be examined because it is a waste of young people and resources. Sir Ron will also examine the standard of all the qualifications that have already been studied by the School Curriculum and Assessment Authority and Ofsted, and the effect of increasing modularisation. Given Sir Ron Dearing's reputation, I do not think that my hon. Friend need have any fear.

Further Education Funding Council (Grants)

Mr. Burden: To ask the Secretary of State for Education what conditions attach to the release of £50 million grant withheld from the Further Education Funding Council for 1995–96. [19173]

The Parliamentary Under-Secretary of State for Further and Higher Education (Mr. Tim Boswell): Grant will be released to the council as colleges certify their commitment that all contracts entered into with lecturers during 1995–96 will be as flexible as their contracts signed with newly appointed lecturers last year.

Mr. Burden: Is not the reality that the Government are using cash penalties to force college managements to impose on their staff the conditions that the Government want? Does not that make nonsense of the Government's claim of flexibility, and does not the Minister realise that it is undermining industrial relations, prolonging the dispute in places such as Birmingham and doing nothing to improve relations between college managements and their staff?

Mr. Boswell: The Government and the taxpayer have a very strong interest in flexibility and efficiency in the delivery of the further education system, expenditure on which runs to nearly £3 billion of public money and which has targeted an increase of 25 per cent. in student enrolment in a short period. It is imperative that that is delivered in general. The Government have no intention of intervening in the day-to-day or detailed negotiations that take place between individual colleges or, indeed, the colleges employers forum and the respective unions. We said that we would welcome the opportunity for those parties to come together. I have today written to the general secretary of the Association of Teachers and


Lecturers commending him on his readiness to take his union into discussions at the Advisory, Conciliation and Arbitration Service with the colleges employers forum. I hope that the National Association of Teachers in Further and Higher Education will follow suit.

English Language

Mr. Hawkins: To ask the Secretary of State for Education what are the aims of her campaign to promote the English language. [19174]

Mrs. Gillian Shephard: Raising standards in English has been at the heart of our education reforms.

Mr. Hawkins: I welcome my right hon. Friend's answer. Does she agree that, in the interests of children, parents and employers, it is absolutely essential for children to learn to use plain, correct and effective English? Is not one of the great problems with the socialist ideas in education peddled since the 1960s that employers complain that those leaving state education after 11 years are unable to use their own language properly?

Mrs. Shephard: Indeed, it is very important that the revised national curriculum puts greater emphasis on the teaching of written and spoken standard English, on grammar, spelling, punctuation and the need for correct English across the curriculum. It is a great sadness that Opposition Members chose to vote against the national curriculum, means of testing it and independent inspections.

Mr. Tipping: Will the Secretary of State look specifically at management-speak in education, where better class sizes has come to mean more pupils and fewer teachers? Is not that a perversion of what parents want?

Mrs. Shephard: I am not sure that the hon. Gentleman's use of English was entirely correct, but you, Madam Speaker, are in charge of such matters. I have already made my views on class size perfectly clear. Many variables affect how teachers perform in classes of different size, but there is no accumulated research evidence to link class size and attainment.

Mr. McLoughlin: When my right hon. Friend looks at the promotion of the English language, will she consider the video that has been released by her Department to commemorate VE day and VJ day? Is she not concerned about some of the criticism levelled at the video by a certain newspaper, or is she satisfied that it will ensure that the right message reaches all our children throughout the country?

Mrs. Shephard: The point of the videos and the packs is to help pupils understand the significance of VE and VJ commemorations. They will run alongside the national curriculum. For the sake of reassurance, I am glad to say that my hon. Friend the Minister of State for the Armed Forces has examined the packs in detail, was involved in monitoring them and is delighted with them. Given his relationship to Sir Winston Churchill, the House can also be reassured.

Teachers' Pay

Mr. Fisher: To ask the Secretary of State for Education when she last met local authority associations to discuss the funding of teachers' pay. [19175]

Mrs. Gillian Shephard: I discussed the funding of the 1995–96 school teachers' pay award at a meeting with representatives of the National Employers' Organisation for School Teachers on Monday 13 March.

Mr. Fisher: Does not the Secretary of State understand the frustration of teachers throughout the country at the Government's refusal to fund the teachers' pay review and at their phoney explanations for that refusal? She knows that surplus funds are not evenly distributed or available for that purpose. She knows that LEAs such as mine in Staffordshire have taken effective action to remove surplus places. She knows the damage that the refusal to fund the settlement will do in terms of larger class sizes, fewer resources and lower standards. Why does she not fund it? Is not the answer that her Government neither care nor want to fund the award?

Mrs. Shephard: We are spending record amounts on education. I remind the hon. Gentleman that the independent review body took into account the affordability of the teachers' pay award. It took into account the £700 million held in schools' balances, the £500 million held in local authority balances, the £250 million taken up by surplus places, the £500 million being spent on administrative and clerical posts that the Audit Commission said could be done without and, finally, the £1.2 billion in uncollected rates, community charge and council tax. All that confirms the independent review body's view that the pay award was affordable if local authorities identified their priorities—unlike Northumberland.

Mr. Dunn: Is the Secretary of State aware that on the day that Lib-Lab controlled Kent county council decided not to fund the teachers' pay settlement it had more than £150 million in reserve? The same county council spends £12,000 per week on conferences and hospitality and £10,000 per week on periodicals and magazines for officials and last year it underspent by £17 million. It is fast becoming one of the worst-run local education authorities in the western world.

Mrs. Shephard: My hon. Friend, as ever, gives a cogent illustration of the point that Conservative Members have been making consistently—poor old Kent.

Dr. Wright: Is the Secretary of State aware that 20 schools in my constituency will lose 18 teachers between them this year? Does she understand that she adds insult to injury by apologising for the meanness of this year's settlement, which does nothing to help schools? I relay to her a question put to me by the head teacher of one of those schools, which is due to lose three staff this year. He wrote to me this week and asked, "Will the Secretary of State please stop sending me expensive brochures about things I have to do when I do not even have the hooks and the teachers to do the basics?"

Mrs. Shephard: Perhaps I could offer the hon. Gentleman a question to relay to Staffordshire local authority, which I understand has about £68 million in reserve.

Mr. Haselhurst: Does my right hon. Friend agree that there is a significant difference between the number of teachers who might lose their posts and the number who


need to lose their posts? When a school with a budget of £1.75 million must make a saving of £20,000 the obvious conclusion is not to make teachers redundant.

Mrs. Shephard: Teacher numbers fluctuate each year. There is a turnover in such a large work force of some 30,000 annually. I do not expect large numbers of redundancies this year. Last year we were told that there would be many redundancies, but in fact teacher numbers increased by 1,000. There may have to be some adjustments in some areas, but one would expect that in view of fluctuations in pupil numbers and other organisational changes.

Mr. Blunkett: Does the Secretary of State agree that her recent so-called charm offensive would have been a great deal more charming and a great deal less offensive if she had decided to provide the money for children in the coming year rather than salting it away for tax cuts next year?

Mrs. Shephard: The hon. Gentleman has been practising that point in his press release. Whatever the Chancellor of the Exchequer may decide about tax policy, firm control of public finances must be at the centre of successful economic policy. I do not think that that lesson has ever been learned by Labour Members.

Mr. Patrick Thompson: In any discussions that my right hon. Friend may have with local education authorities or others, will she continue to emphasise the damage that any strike or industrial action could do in our schools? Is she aware that the result of a massive vote was announced yesterday by the Professional Association of Nursery Nurses, which has decided to join with the no-strike Professional Association of Teachers? Is that not an important and welcome development?

Mrs. Shephard: I certainly think that the Professional Association of Teachers sets a marvellous professional example to its colleagues. I hope that other organisations will take the message that the number in the Professional Association of Teachers is being enhanced by so many. My hon. Friend, as always, makes a very useful point.

Grant-maintained Schools

Mr. Morgan: To ask the Secretary of State for Education what plans she has for amending the law in relation to the holding of financial balances by (a) locally managed and (b) grant-maintained schools. [19176]

Mr. Robin Squire: My right hon. Friend has no such plans.

Mr. Morgan: Do the Government agree in that case that it is totally two faced to set up a large number of systems for grant-maintained schools, for the local management of schools, for training and enterprise councils and GP fundholders—all of which require these new mini-quangos to hold financial balances—and at the same time criticise them for holding those balances? If the Government did not want them to have to hold balances, why did they set up all those mini-quangos in the first place?

Mr. Squire: Within the rules of the House, I might ask the hon. Gentleman to repeat that question, because I

think that I lost him a hit when he got on to GP fundholders, which is not something I have previously answered for at the Dispatch Box.
On grant-maintained schools generally, unless things are organised dramatically differently in the Principality, balances are held by grant-maintained schools in roughly the same way as they are by local education authority schools. The majority of schools save for specific projects, but Ofsted and the Audit Commission have commented that a number do not. That is what has attracted comment.

Sir Malcolm Thornton: Is not it a fact that many of our schools hold balances for a huge variety of reasons? Is not it also a fact that one of the reasons is the way in which the local funding formula operates, and that some of the questions that have been directed to my right hon. Friend the Secretary of State should more properly be directed to the LEA, questioning why the funding formula can so often disadvantage many schools in that LEA?

Mr. Squire: My hon. Friend is, of course, absolutely right that there are a variety of reasons why schools hold balances and, indeed, acquire them. The central issue is that the success of the local management of schools has encouraged governing bodies to take a much greater say in the control over their schools, and a logical extension of that is grant-maintained status, to which earlier comments have been addressed.

Mr. Jamieson: Is not the Minister concerned that, because of the liability for grant-maintained schools to pay value added tax in the past financial year, £l7 million was spent on tax rather than books?

Mr. Squire: The short answer to the hon. Gentleman is, no, I am not concerned. Their VAT treatment follows from the nature and status of grant-maintained schools, and the Government have no plans to change that.

Drug Abuse

Mr. Butler: To ask the Secretary of State for Education what action to discourage drug abuse is under way in primary and secondary schools. [19177]

The Minister of State, Department for Education (Mr. Eric Forth): My right hon. Friend has committed the Department and the education service to playing a full part in the Government's strategy for drug prevention. The national curriculum requires all primary and secondary schools to teach about the harmful effects of drugs. Following recent consultation, we shall issue next month our circular on drug prevention and schools, with curriculum guidance on teaching about drugs, and a digest of drug education teaching materials. In addition, a range of innovative projects on drug prevention, supported by the Government, started this month.

Mr. Butler: Will my hon. Friend take the opportunity to refute the mendacious and malicious misinformation put about by Nigel de Gruchy, which suggests, totally falsely, that the Government recommend that we go soft on the use of drugs in schools? Does my hon. Friend share my regret that, once again, one of the leading teacher


unions has shown itself incapable of properly representing the interests, not of its extreme left wing, but of the pupils whom it is supposed to serve?

Mr. Forth: Could that possibly be the same Mr. dc Gruchy who was reported in The Independent on 22 April as saying:
is it better for a child to steal a car or to disrupt classes … I suppose I would choose kicking a car in."?
I would have thought that the judgment of anyone who makes a statement such as that must be—I shall put it as delicately as possible—somewhat suspect. That same individual has obviously failed to read my right hon. Friend's circular on drugs in schools, which states quite unequivocally that the Secretary of State would normally expect teachers to report matters related to drugs to the police. There is no softness of approach here. My right hon. Friend and I are absolutely determined to tackle the problem of drugs in schools with great vigour.

Mr. Ronnie Campbell: Does the Minister agree that in our wish to tackle the drugs problem, especially at primary school level, there is a fine balance to be struck in the way that we teach children about drugs and what they can do to people? It is a thin line because if we teach them too much, they get to know too much and by the time they reach secondary school they are actually taking drugs.

Mr. Forth: I well understand the hon. Gentleman's point; it is a concern that is frequently raised. We have to judge whether it is better to tell our young people sensibly and responsibly, and in the right context in schools, about matters such as sex and drugs, or whether to allow them to remain ignorant and to learn, in the wrong places and from the wrong people, the wrong message about those matters. The balance of our judgment—which is widely shared, as has been shown by the wide support for our circular—is that the right way to proceed is to tell young people in the proper way about the dangers of drugs, sex and sexual abuse, rather than leave them in ignorance.

Truancy

Mr. Ian Bruce: To ask the Secretary of State for Education what action she is taking to combat truancy. [19178]

Mr. Forth: In addition to the publication of pupil absence data, the Department is supporting locally devised projects to a value of £15.4 million in some 90 English local education authorities under the truancy and disaffected pupils programme of the grants for education support and training—GEST—scheme for 1995–96.

Mr. Bruce: I thank my hon. Friend for his excellent answer about what the Government are doing. Does he agree that the primary group dealing with truancy must be the schools, working with parents to ensure that we cut down truancy as much as possible? What effect will the spotlight of publicity on recording the level of truancy in every school have on the truancy figures for the coming year?

Mr. Forth: I am convinced that, for too long, we have allowed absence from school to go unreported, unrecorded and, to a large extent, unnoticed and not properly dealt with. My firm belief is that in highlighting the problem and bringing out the facts about

non-attendance at school, we, working with people involved in education, can tackle the problem and ensure that all our young people are in school or being educated—because if they are not in school, they are at risk.

Mr. Blunkett: Will the Minister tell the House what he would think of a head teacher who had a group of disaffected students outside his school, but allowed them back in even though they had not promised to improve their behaviour or to agree to follow school rules? Does he agree that the result would be to undermine the credibility of the head teacher and the discipline of the school?

Mr. Forth: Unlike the hon. Gentleman and his right hon. and hon. Friends, I do not query the discretion, judgment or infinite wisdom of head teachers or anyone else in charge of groups of people.

Mr. Mans: Does my hon. Friend agree that one way to reduce the truancy level would be to increase the number of teachers in classrooms? Will he comment on what has happened in Lancashire, where there are 12,300 teachers to teach 217,000 pupils, a ratio of less than 18:1—yet the true ratio in three quarters of classes in Lancashire is more than 30:1? That means that 4,000 teachers are not teaching pupils in classes. They are outside schools, when they could be better employed inside schools.

Mr. Forth: I hope that, following my hon. Friend's question and a similar question from my hon. Friend the Member for Lancaster (Dame E. Kellett-Bowman) earlier, parents in Lancashire will be asking searching questions about what on earth is happening in their county. It appears that there is a rather odd relationship between the number of pupils, the number of teachers and class sites. I know that my hon. Friends will help parents to get to the bottom of the matter and sort out education in Lancashire.

Older Student's Allowance

Mr. Turner: To ask the Secretary of State for Education what representations she has received regarding the withdrawal of the older student's allowance. [19179]

Mr. Boswell: My right hon. Friend has received a number of representations, including those from university administrators and student unions.

Mr. Turner: In terms of encouraging older students to enter higher education, the mature student's allowance has been an outstanding success. How can a Minister with responsibility for education justify a Treasury-led cut that will bring such hardship and difficulties to thousands of mature students?

Mr. Boswell: Any Minister with responsibility for education must consider all priorities in the context of the huge public expenditure on student support and universities, amounting to £6 billion a year in England alone. It is our view that, given that older students receive the full battery of mandatory award—grants and loan provisions from the access fund—and that many of them initiated a career and built up savings, every chance exists that they will continue to come to university in the numbers that have been expanding so rapidly in recent years. The position of all those already on courses has been safeguarded by my right hon. Friend's proposal.

Oral Answers to Questions — PRIME MINISTER

Engagements

Q 1. Mr. Livingstone: To ask the Prime Minister if he will list his official engagements for Tuesday 25 April. [19198]

The Prime Minister (Mr. John Major): This morning I had meetings with ministerial colleagues and others. In addition to my duties in the House, I shall be having further meetings later today.

Mr. Livingstone: Will the Prime Minister join, I am sure, all Members in the House in condemning the use of the word "nigger" by the comedian Bernard Manning, and endorse the comments of the local chief constable that that was a vile, racist performance, and that he would rather that no one among his force went to further performances by Bernard Manning? Will the Prime Minister write to Bernard Manning and remind him that such views, in the year in which we commemorate the sacrifice that our parents made to defeat Nazism, are particularly offensive?

The Prime Minister: I certainly think that everyone should avoid expressions that give offence to those who are on the receiving end of such expressions. That is true of Mr. Manning and everyone else.

Sir Jim Spicer: Does my right hon. Friend agree that the open recruitment of homosexuals into the armed forces, and the acceptance of homosexuality in the armed forces would devastate morale within our excellent service?

The Prime Minister: I have sympathy with the point put to me by my hon. Friend. I know that it is a concern shared by the chiefs of staff.

Mr. Blair: Has the Prime Minister had a chance to see the extraordinary spectacle of the victory parade by his Euro-rebels over the Government on the lunchtime news? Can the Prime Minister therefore tell us whether he has even secured the minimal guarantee from those rebels that, on a future vote of confidence—[Interruption.]

Madam Speaker: Order. Calm down—all of you.

Mr. Blair: Has the Prime Minister secured even the minimal guarantee from the Euro-rebels that, on a future vote of confidence on Europe, they will support him?

The Prime Minister: I can sense the concern in the right hon. Gentleman's voice. Perhaps he would like to tell me whether he has received the support of the 50 MPs who defied his Front Bench over Maastricht; of the 40 who defied him over European finance; on a single currency, where the right hon. Member for Copeland (Dr. Cunningham) was in dispute with the deputy leader of the Labour party; and on clause IV, which half his, I think he called them, infantile MEPs want to keep. He does not, and his deputy leader does

one day and does not the next. These are party matters. Will the right hon. Gentleman tell us what his position is?

Mr. Blair: There is one very big difference—I lead my party, he follows his. [Interruption.]

Madam Speaker: Order.

Mr. Blair: rose—[Interruption.]

Madam Speaker: Order. This is using up very valuable time.

Mr. Blair: So the short answer is that the right hon. Gentleman has received no guarantee whatever. So is it not clear therefore that, after all his tough talk at the beginning about no unity through appeasement, he has caved in, his party is still divided and the white flag flies over Downing street?

The Prime Minister: I look forward to the right hon. Gentleman leading his hon. Friends below the Gangway. I shall give the right hon. Gentleman a real difference. We have been leading in Europe. He will follow in Europe on every issue. He will follow Europe in undermining our veto, in renegotiating our rebate, in surrendering our opt-out, in signing up to the social chapter, in higher taxes, in more spending and in more red tape. His idea of the red flag is the white flag on every conceivable European issue. If he seriously thinks that he leads his party, he should look at the faces of his colleagues below the Gangway.

Mr. Alan Howarth: Does my right hon. Friend agree that the Conservative party has traditionally and rightly been loath to allow power to the state that could be used to limit personal freedom unduly, to harass or intrude on privacy? Does he accept that the alleged benefits of introducing identity cards would not justify the risks to civil liberties? Will he dismiss proposals for a national identity card, whether compulsory or so-called voluntary?

The Prime Minister: I am afraid that on this issue I cannot agree with my hon. Friend. I believe that there are significant advantages which identity cards may offer to prevent crime and to prevent fraud. It is for that reason that my right hon. and learned Friend, the Home Secretary, intends to publish a Green Paper setting out the various options that are available. We believe that on such an issue it is only right that there should be full public consultation. No option at the moment is ruled in or ruled out until we have completed that consultation period. I believe that it is right to consult. When we have consulted, we will make a decision on whether to proceed and what nature of card we may then seek to introduce.

Mr. Rendel: To ask the Prime Minister if he will list his official engagements for Tuesday 25 April. [19199]

The Prime Minister: I refer the hon. Member to the answer I gave some moments ago.

Mr. Rendel: Given that the level of balances held by county councils is already considerably lower than the level that the Government assume in their calculation of grants to those councils, how does the Prime Minister


justify calls by himself and many of his hon. Friends that county councils should further run down their balances to make up for the Government's education cuts?

The Prime Minister: As I have indicated to the House before, perhaps when the hon. Gentleman was not here, the levels of expenditure on education have risen, not fallen. Of course, in different counties different priority is given to education. Some education authorities—Conservative Brent, for example—have found it possible to increase their spending on education by 6 per cent. Other councils have done the same. It depends on the choices that councils themselves make. I regret that many Labour councils and many Liberal Democrat councils have chosen not to give the priority to education that I would have preferred.

Mr. McLoughlin: Will my right hon. Friend consider today the many changes that the Conservative party has brought about in education policy in the past 16 years, which have widened and diversified choice? Will my right hon. Friend have a word with the Secretary of State for Education about whether it is time to move one stage further to a national funding formula for education? Is he aware that in Derbyshire the local education authority holds back £720 per pupil compared with £570 in Nottinghamshire, and £550 in Staffordshire? If that money went directly to the schools, there would be no need for any cuts in the number of teachers in our schools. Is it not time that we started to show up the money which LEAs spend in county hall rather than in the schools in our constituencies?

The Prime Minister: I think that my hon. Friend speaks for many people in what he has just said. Many responsible education authorities are coping with this year's settlement by getting their priorities right and by ensuring that the bulk of resources go to front-line services such as schools. Many Labour education authorities are not doing that. They seem to be in the lead in financing a messy bureaucracy. I do not know the position in Labour-controlled Derbyshire, but no doubt my hon. Friend does and was correct.

Mr. Win Griffiths: To ask the Prime Minister if he will list his official engagements for Tuesday 25 April. [19200]

The Prime Minister: I refer the hon. Gentleman to the reply I gave some moments ago.

Mr. Griffiths: Does the Prime Minister recall telling the House on 21 March that there were two administrators for every three teachers across the country? Where did he get those fictional figures, when the Department for Education and the Welsh Office have said that it is impossible to calculate a ratio of administrative staff to teachers? When outside experts have tried to calculate a ratio, they put it at about 1:8 rather than 2:3. Will he now apologise for misleading the House inadvertently with his spurious reference to that ratio, which was a feeble effort to divert attention from his miserly decision not to fund the teachers' pay award?

The Prime Minister: The hon. Gentleman took a long time to he wrong. [Interruption]—Yes, I suggest that he has a look at the figures in "Social Trends".

Mr. Day: Does my right hon. Friend agree that there is a new consensus in British politics, which is based very

much on Conservative principles? Does not the the Leader of the Opposition pay the Government the greatest compliment by spending most of his time trying to convince the country that when the day comes when he has a policy of his own, it will be a Tory one? Does my right hon. Friend also agree that if the people of this country were to support that new consensus, which was created by the Conservative party, the best thing that they could do is to vote Conservative and not for the vacuous, pale imitation on the Opposition Benches?

The Prime Minister: The right hon. Gentleman both criticises our policies and copies our policies whenever he can. I am content for him to do that. I regard imitation as a very sincere form of flattery.

Mr. Jim Marshall: To ask the Prime Minister if he will list his official engagements for Tuesday 25 April. [19201]

The Prime Minister: I refer the hon. Gentleman to the reply I gave some moments ago.

Mr. Marshall: In response to a previous question, the Prime Minister referred to high taxation. In that context, will he inform the House how much extra taxation the average family in this country is paying compared with the amount paid in April 1992?

The Prime Minister: I can tell the hon. Gentleman, and he will be pleased to know, that even after extra tax and inflation, households on average are expected to be about £250 better off this year. I can also tell him that most of the figures used by the Labour party about tax should be divided by two before one gets remotely near accuracy.

Mr. Luff: Whatever the rights and wrongs of teaching children in classes of more than 30, does my right hon. Friend agree that it would be repellent for teachers to pick on some children in such classes and expel them from lessons? Is not that an appalling abdication of responsibility for the education of our children?

The Prime Minister: I agree with my hon. Friend. I do not think that removing children from classrooms where there are more than 30 pupils will appeal to very many teachers. I know that some people have suggested it. I believe that the common sense of the vast majority of teachers will reject any such notion.

Mr. Berry: To ask the Prime Minister if he will list his official engagements for Tuesday 25 April. [19202]

The Prime Minister: I refer the hon. Member to the answer I gave some moments ago.

Mr. Berry: In recent debates on the Government's Disability Discrimination Bill, they have suggested that citizens advice bureaux will be important in enforcing the Bill's provisions. Is the Prime Minister aware that the National Association of Citizens Advice Bureaux has just said that it is in no position to do so? How on earth does he expect the provisions of that Bill to be enforced?

The Prime Minister: The Bill contains a wide number of provisions. It also contains the provision for the National Disability Council to advise the Government on such issues and we will take whatever advice it chooses to give us on that issue.

Mr. Gallie: Has my right hon. Friend seen the excellent report from Scottish Nuclear today, which shows that the cost of generation has been reduced to 2.2p per kWh—without the nuclear levy enjoyed by Nuclear Electric? Does he feel that that suggests that, if

the Government ever picked privatisation for the nuclear industry, Scottish Nuclear could do a magnificent job as a single entity?

The Prime Minister: We are very close to the completion of the nuclear review and an announcement about its conclusions will be made and a White Paper published as soon as possible. We will present the conclusions to Parliament at that time. Privatisation of the two nuclear generators before the next election is an option that is actively under consideration and so is the future of the fossil fuel levy.

Points of Order

Mrs. Elizabeth Peacock: For the first time in my years in the House I rise on a point of order to seek your help and guidance, Madam Speaker. This is a matter of courtesy between colleagues, about which you have expressed concern. During the past four weeks, three senior Opposition Front-Bench spokesmen have visited my constituency. Not one had the courtesy to send me a note of the visit. They were the hon. Members for Blackburn (Mr. Straw), for Peckham (Ms Harman) and for Sheffield, Brightside (Mr. Blunkett). Of course, I sent them a note to say that I would raise this point of order referring to them. During those visits, two of them visited projects that are up and running only due to my lobbying in the House for Government finance. I seek your help and guidance on how we might prevent that sort of thing from happening in future, as it is a discourtesy.

Madam Speaker: I cannot help the hon. Lady, but I can give the House guidance, as I have done on numerous occasions. I expect hon. Members to inform each other when they are visiting other Members' constituencies in a public capacity. I have said so on numerous occasions. As the House knows, I have no authority to ensure that that is carried out.

Mr. Terry Lewis: On a point of order, Madam Speaker. Last week, when two hon. Members were suspended, you said that they could use their offices provided that they took the direct route. Have you changed the policy, because some of my hon. Friends, who have been expelled for what some of us would consider trivial reasons, have been banished from the premises? What is worse, they have been taken ignominiously to their offices by the Serjeant at Arms and escorted through the gate. Will you clarify the matter for the House?

Madam Speaker: The hon. Member obviously wants some explanation. Access to the House is a matter for the Speaker. There is an anomaly between the Standing Order—[interruption.] Just a moment. Let us have a little quiet as this is a serious matter. There is an anomaly between suspensions made under Standing Order No. 43 and suspensions made in other circumstances, as laid down in "Erskine May". When the House suspends a Member under the Standing Order, he or she is not allowed to enter the precincts. According to "Erskine May", when a matter has gone before the Privileges Committee and a Member is suspended from the House, that Member is not excluded from the precincts, unless the order for his suspension expressly provides for that. That is an intolerable situation, which is why I chose the compromise of allowing those Members to have access to their offices, but by the most direct route only. I have referred the matter to the Procedure Committee because I

am not satisfied with how it stands. I want a clear ruling from that Committee so that it will be clear for all hon. Members in future.

Mrs. Alice Mahon: Further to the first point of order, Madam Speaker. Does the same judgment apply to Ministers? Last week, a Minister came to my constituency to visit a crumbling school that desperately needs some money—he did the Labour party good because he said that he would not give us the money. He visited Withinfield school in my constituency and did not inform me. When a local councillor, who was there to meet him, asked where the money would conic from, he stayed away for two and a half hours because he did not want to face the flak.

Madam Speaker: Yes. My ruling affects everyone.

Mr. Mike Hall: rose—

Madam Speaker: Is it a me-too-ism?

Mr. Hall: Yes, Madam Speaker. Further to that point of order, the Secretaries of State for Education and for the Environment recently visited my constituency, both without the courtesy of informing me that they would do so. Will you pass judgment on that as well?

Madam Speaker: I do not exclude Ministers from this ruling. I see that the Leader of the House is on the Treasury Bench. I know how keen he is on this matter and I hope that he will assist me in letting Ministers know that their offices should inform hon. Members when Ministers are to visit an hon. Member's constituency.

Mr. Iain Duncan Smith: On a point of order, Madam Speaker. I seek your guidance because, during Prime Minister's questions today, I and a number of my colleagues noticed that at least two or three persons who are no longer members of the press but are now advisers to the Leader of the Opposition were in the Press Gallery. Should they be there at all, given that they no longer work for organs of the press with official press passes?

Madam Speaker: From where I sit, I can see no one in the Press Gallery. I should like the evidence from the hon. Gentleman and I shall then make a decision about it.

Mr. Paul Flynn: On a point of order, Madam Speaker. I am sure that you and the rest of the House would thoroughly agree with the Prime Minister when he said today that we should not use derogatory expressions that give great offence to those against whom they are aimed. Are you aware of the expression being used, as a result of which the person against whom it was used said that he felt like Cardigan at the charge of the Light Brigade, and he does not want to be referred to as a Conservative again?

Madam Speaker: Order. That has nothing to do with the Chair. It is one of the usual bogus points of order that I get at this time on a Tuesday.

Road Traffic Reduction

Mr. Cynog Dafis: I beg to move,
That leave be given to bring in a Bill to establish targets for a reduction in road traffic levels in the United Kingdom; to require local authorities to draw up local road traffic reduction plans; to require the Secretary of State to draw up a national road traffic reduction plan to ensure that the targets are met; and for related purposes.
Some two years ago, I introduced under the ten-minute rule an Energy Conservation Bill. At that time, energy conservation was not a subject of passionate debate in the House but, for a number of reasons, it became so. Following a vigorous campaign and through a tortuous process, and thanks to the fact that it was adopted by the right hon. Member for Berwick-upon-Tweed (Mr. Beith) and the hon. Member for Christchurch (Mrs. Maddock), a Home Energy Conservation Bill based on it has completed its passage through the House and should be on the statute book before long.
The Road Traffic Reduction Bill that I am introducing today is, in many ways, similar. Its starting point is the imperative of moving towards environmental sustainability, but it has important social, economic and health implications. It gives local government a central role, modelled on that in the Energy Conservation Bill. A major difference is the fact that its subject is already a matter of passionate debate.
It is particularly timely that I should be introducing this Bill a few days after the publication of the Environment Select Committee's report on volatile organic compounds, just one of the pollutants produced from road traffic exhausts. That report follows the royal commission report on transport and the environment; the report of the Standing Advisory Committee on Trunk Road Assessment referring to the traffic-generating effect of road building; and the Transport Select Committee's report on road traffic emission.
The health effects of traffic emissions, particularly affecting children, have concentrated our minds on the issue. A cocktail of pollutants—nitrogen oxides, carbon monoxide, polyaromatic hydrocarbons, particulates and volatile organic compounds—are, in all probability, linked to the doubling of asthma among children over the past 10 years and the estimate in a report by Lancaster university that 15 million people in the UK suffer health problems as a result of road traffic near their homes. But that is not all. Increasing road traffic swallows up land, reduces biodiversity and consumes natural resources at a huge rate, causing further environmental and other damage in their extraction and processing. It is a major negative factor in reducing the quality of people's lives and almost certainly in fragmenting communities and informal social networks, leading to alienation and an increasing crime rate.
Nearly 4,000 people die on the roads each year and the lives of thousands more are blighted through injury—children and the elderly are the most affected. Road accidents are the main cause of death in the 10 to 14–year-old age group. Small wonder that only 20 per cent. of schoolchildren walk to school today compared with 80 per cent. 20 years ago. That has exacerbated the problem of road traffic.
The recent conference at Berlin confirmed that climate change as a result of human-induced greenhouse gas emissions is, in all probability, a grave reality. The increase in road transport is a major, growing factor influencing climate change. In the United Kingdom, 24 per cent. of CO2 emissions come from surface transport and of them 80 per cent. come from road transport. Between 1970 and 1990, CO2 emissions from road transport almost doubled. If the Government's prediction of a doubling in the number of vehicles on the road by 2025 is fulfilled, it will more than negate the reductions in CO2 emissions achieved through greater efficiency in other sectors.
The planned increase in private car use in so-called "developing" countries such as China, Indonesia and Malaysia constitutes a global problem of staggering proportions. It serves to emphasise the need for developed countries such as the United Kingdom, with direct experience of the negative effects of what was seen at one time as an unmixed blessing, to seek to influence by setting an example. How do we turn the tide?
Many people would place their faith in technological improvements, new fuels and so on. They are important developments, but they merely address the issue of health-damaging pollutants. I can do no better than offer a quotation from the report published last week by the Environment Select Committee, to illustrate the complexity of the issue. It stated:
Road traffic is a major source of many significant pollutants…and any strategy to reduce emissions must take all of these into account. The 'diesel versus petrol' debate illustrates the danger of looking solely at VOCs: the VOC emissions from diesel engines are far lower than those from petrol, but diesel engines emit higher levels of particulates which are now thought to present a greater risk to health than the typical levels of VOCs from a petrol engine. Looking at the problem from a different angle, VOC emissions could be cut dramatically if all non-catalyst cars were immediately scrapped and replaced with new vehicles. However, the manufacture of new cars uses energy and produces carbon dioxide, which may have a consequence for global warming.
It is worth noting the next sentence in the report:
It is now widely recognised that the only sustainable long term solution to traffic pollution is a reduction in traffic growth.
I would go further, because I believe that we should talk about a reduction in traffic. How will that be brought about?
The Government are committed to the use of economic instruments to achieve environmental targets, the annual 5 per cent. real terms increase in petrol duty figures prominent among them. I would not deny the validity of such instruments, which need to considered in the context of the vital debate on environmental taxation as against taxation on people and employment. To depend purely and simply on economic instruments would be ineffective, inequitable and damaging to rural areas such as my constituency, where there is currently little alternative to the motor car and where distribution costs are significant.
The Bill, which has been prepared by Friends of the Earth and the Green party, approaches the problem from the other direction. It requires the relevant Secretary of State to draw up a United Kingdom-wide road traffic reduction plan with targets of stabilisation by the year 2000; a 5 per cent. reduction in traffic by 2005; and a 10 per cent. reduction by 2010. Local authorities are required to draw up plans for reducing traffic through measures related to public transport and rail transport, appropriate planning policies, traffic calming, pedestrianisation and


public education. The royal commission supports the principle of targets as does the Confederation of British Industry.
The report of the Environment Select Committee also stressed the role of local authorities, which is in keeping with Agenda 21's emphasis on local action through local Agenda 21s, in which traffic reduction should be a crucial component. Local authorities have the expertise and detailed knowledge of their areas to devise measures appropriate to them. They alone could facilitate the widespread public consultation and consciousness building that are the essential preconditions for success. Their task would be enormously challenging and exciting, and they would co-operate with each other, sharing ideas and examples of best practice and drawing on the store of ideas that already exist both here and abroad.
I draw the attention of the House to the excellent document from the Campaign for the Protection of Rural Wales, "Wales Needs Transport, Not Traffic", and to the ideas of the Countryside Council for Wales for promoting green holidays, linking public transport with cycling and walking routes.
In continental Europe, there are numerous examples of cities whose achievements in actually reducing traffic levels have been positively received both by the general public and by the commercial sector. The Bill would provide a useful framework for a progressive traffic reduction policy. I invite hon. Members to support it and I look forward to its further progress.

Question put and agreed to.

Bill ordered to be brought in by Mr. Cynog Dafis, Mr. Hugh Bayley, Mr. Dafydd Wigley, Mr. Frank Cook, Mr. Simon Hughes, Mr. Alan Simpson and Mr. Nick Ainger.

ROAD TRAFFIC REDUCTION

Mr. Cynog Dafis accordingly presented a Bill to establish targets for a reduction in road traffic levels in the United Kingdom; to require local authorities to draw up local road traffic reduction plans; to require the Secretary of State to draw up a national road traffic reduction plan to ensure that the targets are met; and for related purposes: And the same was read the First time; and ordered to he read a Second time upon Friday 14 July, and to be printed. [Bill 105.]

Fiftieth Anniversary of the end of World War II

The Prime Minister (Mr. John Major): I beg to move,
That an humble Address be presented to Her Majesty, as follows:
Most Gracious Sovereign,
We, Your Majesty's most dutiful and loyal subjects, the Commons of the United Kingdom of Great Britain and Northern Ireland, in Parliament assembled, recalling the humble Addresses presented to His Majesty King George VI on the 17th May and 21st August 1945, beg leave to express to Your Majesty our joy in commemorating the fiftieth anniversary of the end of the Second World War and of the defeat of the forces of evil which it brought, our thanks for the fortitude of the men and women who served with the armed forces or who participated in the war effort in civilian life between 1939 and 1945, our recognition of the sacrifice made on behalf of future generations by those who died or who were disabled in their country's service, and our desire that the constructive work of peace for which our predecessors in 1945 prayed may continue and grow in the years to come.
It has long been a tradition of the House that we mark significant national events by presenting a humble Address to the sovereign. That was the case in May 1945 when Mr. Winston Churchill moved the motion for such an Address to be presented to His Majesty King George VI. The motion on that occasion expressed the gratitude of the nation for the end of the war in Europe, together with a wish to see a speedy conclusion to the war in the east. That wish was met; just three months later the House was able to present another humble Address to His Majesty after the successful conclusion of the war against Japan.
Throughout the war, the royal family symbolised the unity of the nation and of the Commonwealth, and the willingness to make whatever sacrifices were necessary to ensure victory and the preservation of a free way of life. When Britain stood alone, the courage and determination of the King and Queen offered strength to the British people and to countless millions of people beyond our shores.
It is no surprise that Her Majesty Queen Elizabeth the Queen Mother continues to hold such a special place in the affections of the British people. Many remember, and countless millions who were not alive at the time know, the fortitude and resilience that she and the King displayed throughout the war. The then Princess Elizabeth—a teenager when the war began, now Her Majesty the Queen—played her full part in furthering the war effort, and Her Majesty has continued to set an example of duty and service to the nation and to the Commonwealth throughout the 50 years since then.
The commemoration of the end of the war is not a triumphalist occasion, but an occasion to pay proper tribute to the millions of brave men and women whose lives were cruelly, often tragically, disrupted by the demands of the war that had to be won.
Last year marked the 50th anniversary of the Normandy landings. Everyone who took part in the commemorative events was profoundly moved by them. I, for one, will long remember the march-past of the veterans on the sands of Arromanches. There were thousands upon thousands of them—brave men and women in their 70s and 80s now, often with a chestful of medals and a mind full of memories, some with sticks, some pushed in


wheelchairs, some limping, some walking, some marching, but all moving with pride before the Queen, and with their memories of their service to their nation in the last war.
As the House will know, a number of events are planned to commemorate the 50th anniversary of VE day next month and of VJ day in August. It is appropriate that the prelude to those events should be the parliamentary occasion of presenting a humble Address to the Queen.
Here in the Chamber we have a constant reminder of those days 50 years ago. The Churchill Arch, at the entrance from the Members' Lobby, was rebuilt from the original, damaged in the bombing raids of 1941. It poignantly recalls how even the mother of Parliaments made its sacrifice. As Churchill himself said, all of us present here today, who are uniquely privileged to pass through that Arch, should
look back from time to time upon their forbears who
'—kept the bridge
In the brave days of old.'"—[Official Report, 25 January 1945; Vol. 407, c. 1006.]
As our Parliament sat through the war it symbolised the dogged determination of democracy; a determination to overcome tyranny and dictatorship that was shared by countless millions throughout the world. For the price of sacrifice was paid here, too. Twenty-two Members of the House—together with 35 Members of the House of Lords and five members of staff of both Houses—were killed during the war. Eighteen present Members of the House also saw active service in the war and some, perhaps all, are present here in the Chamber on this occasion. Many others now sit along the Corridor in the other place. For them, the commemorations will hold special memories; and to them, we—who inherit the parliamentary freedom that they helped protect—owe special thanks.
When His Majesty King George VI replied to the humble Address 50 years ago, he said:
It is My most fervent hope that we are entering upon an age of peaceful progress, wherein the natural talent and enterprise of My peoples can be devoted to the advancement of the happiness and prosperity of mankind."—[Official Report, 21 August 1945; Vol. 413, c. 417]
Looking back over the past 50 years, we can see that many of the hopes for peace and reconciliation have been rewarded, but we have not banished conflict and terror throughout the globe. We have troops on peacekeeping and humanitarian duties in many countries. In recent days, there has been the tragic bomb attack in Oklahoma. This House has had direct experience of terrorist attacks, and several hon. Members have been the victims of terrorists.
The successful outcome of the second world war showed the importance of a determined and united effort to defeat military aggression. As we look ahead, we must exercise the same determination as was shown then, to counter the threat from terrorism, not only in the United Kingdom but throughout the world.
Madam Speaker, this is an occasion to look both back and forward. The perils of the last war dwarf the petty rancours of everyday politics today. I believe that our country has many reasons to look forward with hope to the future. I believe that, as we do so, it is right that we should look back thankfully to the sacrifices of the past. The whole House, the whole nation, the whole Commonwealth, will wish to remember and give thanks.

Mr. Tony Blair: It is my privilege to associate myself entirely with what the Prime Minister has just said and with his sentiments about the royal family. It is a time for our nation to speak with one voice of remembrance, of joy at a victory magnificently won and sadness at the loss of life necessary to achieve it.
We remember a triumph that is all the more unalloyed because it was a victory, not as much of nation over nation, as of good over evil. The fight against Hitler and fascism was, and indeed remains, the moral case for taking up arms.
I was born almost a decade after the war ended and it was my father's generation who fought it. On behalf of my generation, I say to his that we pay tribute to their sacrifice and bravery with humility and gratitude. We recall the courage of the troops who fought and, in their millions, died or were wounded. Some of them bear their wounds to this day.
We commemorate, too, the millions of men and women who never left Britain during the war, but who played such a conclusive part in it—the firefighters, the ambulance men and women, the nurses and the police—and who worked, often through the blitz and in as great danger as those at the front. We remember the factory munitions workers, Bevin's boys down the mines, and the steel and ship workers who placed production at full stretch in the war effort.
We reflect, not just on the great battles fought and the medals of honour granted, but on the countless small acts of heroism, which are often unrecorded and the memory of which may be effaced, but whose spirit won the war. The country at that time worked with one heart and one mind to one end, and succeeded. The solidarity of the nation persisted after the war in rebuilding the towns and the cities, putting people back to work, and creating the modern structures of a national health service and a welfare state capable of offering hope to heroes.
So what, at this distance of half a century, are the lessons of the war that we can learn? We learn about pride in our country—there are few nations, if any, that can claim without exaggeration to have helped save the world from tyranny. We learn about the strength of freedom and democracy as motivators of the human soul because we remember, too, today, not just ourselves but the millions in other countries—particularly perhaps those Jewish people in countries conquered by Hitler—who continued to resist, no matter what the cost. We learn about the fragility of peace and the utter catastrophe of modern warfare, which the years before and during the war amply demonstrate. We learn humankind's deadly potential, amidst progress, for regression to primitive barbarity. We know now that if we choose to appease evil as it grows, we shall in the end be forced to fight it when it is fully grown. We think that with all the knowledge of our modern world, such evil can never happen again, but that generation thought that it would never happen at all.
We fought the war, but we did not do so alone. It is right that we remember our allies, and thank them. One of the most moving stories of statesmanship in the war came in January 1941, when defeat for Britain was certainly possible. We desperately needed the help of


America. Harry Hopkins, the emissary of President Roosevelt, was here. At a dinner in his honour in Scotland, he said:
I suppose you wish to know what I am going to say to President Roosevelt on my return.
And then, quoting from the Bible, he said:
whither thou goest, I will go; and where thou lodgest, I will lodge: thy people shall be my people, and thy God my God".
Hopkins then added:
Even to the end".
That was the spirit of those times.
There was no doubt that this was a war to save civilisation. At the end of the war, as within Britain, so outside it, nation co-operated with nation to set up the institutions of international governance to act as a bulwark against disunity and aggression—the United Nations, the North Atlantic Treaty Organisation and, later, the European Community. Amid all the cynicism about them, we should give thanks that there was the vision to build them and that, by and large, their role has been constructive and positive.
Let us hope that such a time of evil will not arise again, but let us never forget that it did. It confronted us with an intensity and menace unsurpassed in our history. Let us give thanks that we rose up against it, defeated it and so provided a future of hope for this generation and the generations yet unborn.

Mr. Paddy Ashdown: I am privileged and delighted to be able to support the words in the motion moved by the Prime Minister and echoed by the leader of the Labour party.
Of course, it is absolutely right that we should express our pleasure to Her Majesty the Queen in celebrating and commemorating that victory of 50 years ago, a victory in which Her Majesty's father and family played such an extraordinary and very large part, in terms of leadership and symbolism.
Speaking in the debate to which the Prime Minister referred, the then Prime Minister, Winston Churchill, said of the royal family:
It is the symbol which gathers together and expresses those deep emotions and stirrings of the human heart which make men travel … and die together, and cheerfully abandon material possessions and enjoyments for the sake of abstract ideas."—[Official Report, 15 May 1945: Vol. 410, c. 2305.]
They may have seemed abstract ideas at the time, although I doubt that they felt them too much, but today they mean to us no less than our freedom, our civilisation, our capacity to have survived such a terrible evil and, of course, above all an expression of our national resolve and national unity. It is therefore right that we should

celebrate, but it is right also that we should remember the pain of those without whose sacrifice that victory would not have been possible.
It is impossible for us to measure the debt that we owe to those who gave, all too often, their lives or, frequently, experienced a lifetime of maimed disability to ensure that we have had this half century being able to enjoy freedom, that a great evil was defeated and that the nations of Europe could come together to seek to banish war from our continent for ever. In the shadow of that, we saw a great unity in our nation and we saw the beginnings of the building of international institutions that also seek to tackle the evil of fascism and aggression in the world today. It is a moment to celebrate; it is also a moment to remember; and it is a moment to pray that the peace for which they paid such a high price may continue for us all.

Mr. Winston Churchill: Does my right hon. Friend the Prime Minister agree that, had it not been for the courage of the British nation around the globe and the steadfastness of the House of Commons and Parliament, the nations of Europe would never have been liberated and that, in such circumstances, it is by no means impossible to imagine that the Nazi swastika would to this day have been flying over the capital cities of Europe?
Will my right hon. Friend make it clear how enormously welcome Her Majesty will be when she comes to the House on 5 May and how appropriate it is that the initial phase of this 50th anniversary commemoration should start here, in the House of Commons?

Question put and agreed to.

Resolved,
That an humble Address he presented to Her Majesty, as follows:
Most Gracious Sovereign,
We, Your Majesty's most dutiful and loyal subjects, the Commons of the United Kingdom of Great Britain and Northern Ireland, in Parliament assembled, recalling the humble Addresses presented to His Majesty King George VI on the 17th May and 21st August 1945, beg leave to express to Your Majesty our joy in commemorating the fiftieth anniversary of the end of the Second World War and of the defeat of the forces of evil which it brought. our thanks for the fortitude of the men and women who served with the armed forces or who participated in the war effort in civilian life between 1939 and 1945, our recognition of the sacrifice made on behalf of future generations by those who died or who were disabled in their country's service, and our desire that the constructive work of peace for which our predecessors in 1945 prayed may continue and grow in the years to come.

Ordered,
That the said Address be presented to Her Majesty by the whole House.—[Mr. Newton.]

Ordered,
That such Members of this House as are of Her Majesty's most Honourable Privy Council, do humbly know Her Majesty's Pleasure when she will be attended by the House with the said Address.—[Mr. Newton.]

Orders of the Day — Medical (Professional Performance) Bill

Order for Second Reading read.

The Secretary of State for Health (Mrs. Virginia Bottomley): I beg to move, That the Bill be now read a Second time.
This is an important Bill. Its purpose is to ensure that high-quality, professional performance is maintained by all doctors in the national health service and in private practice. It will help to ensure that patients receive the standard of caring and up-to-date professional practice that they have a right to expect.
The Government stand for first-class public services and the Bill is part of that commitment. The citizens charter and the patients charter have brought a major change in attitude and performance in the NHS, so that it is now a service centred on patients.

Dr. Norman A. Godman: I am extremely grateful to the Secretary of State. Will she confirm here and now that when she talks about all doctors, she includes in that definition hospital consultants? Most of the complaints brought to me by constituents have concerned the negligence of hospital consultants rather than general practitioners.

Mrs. Bottomley: I can certainly confirm that the Bill refers to all doctors. If I can make a bit more headway before the next intervention, I shall make that absolutely clear.
The Bill is part of our commitment to ensure that the national health service lives up to the highest standards expected by the public. Already, we have had dramatic improvements in the responsiveness and quality of care available. The changes that I recently announced to the systems for handling complaints, following the Wilson report, is part of that movement. Similarly, the new code on openness is a further example of how we are getting better at responding to the needs of patients and the expectations of the public.
The heart of the health service is its doctors, nurses and other clinical staff. Their dedication, professionalism and quality are rightly a source of national pride. They are respected throughout the world.
All of us in the House acknowledge the tough job that clinicians have to do. That demanding job does not get easier when the expectations of the public rise with demographic changes and, inevitably, there is always a finite budget. Only recently, the case of Child B brought into the full media glare some of the complex ethical decisions that clinicians regularly face in their normal working lives.
Doctors have been at the forefront of the culture change in the NHS. They are now rightly expected to be held accountable for the vast sums of taxpayers' money that they spend, as well as for the care that they provide. Most doctors recognise that as a valid feature of a modern health service, where it is no more acceptable knowingly to misuse its resources than it is to pursue a course of action which is clinically unsound.
The NHS has to be well and strongly managed. Many doctors respond positively to that by becoming involved in the management of the service, whether through GP fundholding, for example, where family doctors are able to back their clinical judgment by direct access to the budget that they control, or through the other many opportunities as medical or clinical directors of the new health authorities, as directors of public health or by offering professional advice. There are now unlimited opportunities for doctors to influence and shape the development of the health service.
Doctors are no longer the unchallenged paragons they once were in the eyes of the public. Patients are better informed, more assertive and more ready to question and complain. That certainly puts pressure on the medical profession, which is held to account in an ever more public atmosphere.
A new climate is spreading, where treatments are analysed on the basis of clinical effectiveness and outcomes. Clinical audit is well established. Our pioneering research and development strategy is spreading on a systematic basis information about the latest state of medical knowledge. Tomorrow my hon. Friend the Minister will be launching the next phase of our movement towards evidence-based medicine with the Cochrane collaboration. All those changes mean that the practice of medicine takes place ever more in the limelight and is subject to increasing scrutiny.

Mr. William O'Brien: I appreciate the opportunity to intervene on the Secretary of State and I acknowledge the report that she has given about doctors. Will she confirm or deny that she intends to introduce performance indicators for doctors and other clinicians in the health service? How will that system operate if she intends to introduce it?

Mrs. Bottomley: I have no such intentions; I am simply describing the atmosphere in which medical practice now takes place. It is subject to scrutiny and evaluation in a way that was inconceivable even 10 years ago and it means that all doctors are under greater pressure to keep up to date with the latest advances in medicine. As medicine becomes more complex, capable and involved, there is a pressure and an obligation on all professionals to ensure that they are protecting their patients and serving them according to the latest knowledge and understanding of care.
In general practice it is now often possible to treat and to manage diseases, such as heart disease, stomach ulcers and asthma, which once required a high degree of hospital care. Doctors, particularly in family health services, used to work in professional isolation. Today fewer general practitioners work alone because there is a much greater emphasis on team working. GPs and specialists increasingly work side by side in modern medical centres, bringing what was once thought of as hospital care closer to patients. Nurses, doctors and other professionals work together in community health teams and there is closer working between GPs and clinicians in hospitals.
That does much to improve the treatment and care of cancer sufferers, for example. Only yesterday, we unveiled our framework for the future of cancer services. That close linking and greater sharing of knowledge between GPs and clinicians in hospitals and the patients and public is a theme of that new framework. All those new developments mean an unprecedented change in the


way in which modern medicine is delivered. A doctor has a clear duty to keep up to date, to know what is appropriate and what is not, and to know when to seek help and advice from colleagues.
To its credit, the profession has recognised those changes and the need that comes with them to assess continually the performance of doctors. I pay tribute to the General Medical Council whose work has resulted in this Bill. The Bill stems from the profession's recognition that, no matter how qualified, dedicated or expert the majority of its members may be, the standards demonstrated by a small number of practitioners will from time to time fall below what patients have a right to expect. In those cases, proper procedures must exist that will enable action to be taken to protect patients and to raise the quality of care.
When doctors arc guilty of serious professional misconduct or when a doctor's fitness to practise is seriously impaired by ill health, the powers exist to act. Doctors who are accused of serious misconduct appear before the GMC's professional conduct committee, where the evidence is tested to the criminal standard of proof in adversarial proceedings. Doctors who are found guilty can be struck off. Similarly, the GMC has powers to suspend from the register those doctors who are too ill to perform their duties.
However, no such powers exist to deal with doctors whose performance may be seriously deficient but who, nevertheless, fall short of those extremes. The GMC receives details of a number of cases upon which it cannot take any formal action, even though it may be apparent that the underlying performance of the doctor concerned is very poor. At present, those doctors are beyond the law; they can remain on the register and the council has no power even to require them to address their shortcomings. That is bad for patients and bad for doctors.
The Bill plugs the gap. It is a Government Bill, but the House will be aware that the initiative came from the GMC. I pay a warm tribute to Sir Robert Kilpatrick, president of the GMC, who has been the primary influence behind the changes. He set up a working group to examine the problem and he single-handedly carried through consultations with a wide range of individuals and organisations both within and outside the medical profession. A period of formal consultation followed in 1992, and in November of that year Sir Robert secured the agreement of the GMC to proposals that differ little to those which appear in the present Bill. Indeed, I can say that, on being appointed as Secretary of State, three years ago, almost the first invitation that I received was to discuss with Sir Robert these proposals and how we could secure a journey to the legislative Chamber to ensure that they were enacted.
Sir Robert retires at the end of August this year. If enacted, the Bill will be a fitting tribute to his energy, determination and powers of persuasion as well as to an outstanding period as president of the GMC. In large part due to his efforts, the measures in the Bill command the wide support of the medical profession. They also enjoy cross-party support. I am grateful to the right hon. Member for Derby, South (Mrs. Beckett) for the support that she has given to the Bill in principle, and to the Liberal Democrat spokesman similarly. The hon. and learned Member for Montgomery (Mr. Carlile) sits on the

GMC, as does the hon. Member for Gower (Mr. Wardell) and, indeed, my hon. Friend the Member for Chislehurst (Mr. Sims), to whom I pay particular tribute, as he is the longest-standing Member of Parliament on the GMC and has been closely involved in the "fitness to practise" proceedings.
It may be of assistance to the House if I speak at this stage about the GMC in a little more detail. The GMC is the self-regulatory body of the medical profession. It consists of 102 members, 89 of whom are qualified doctors, the rest representing different professional and lay interests, including, as I have said, Members of Parliament from each of the main political parties. The House will be aware that, at present, the GMC is taking forward proposals to increase its lay membership—a further example of the need for all professions to ensure that they carry the confidence of the public in the vital work that they do.
The GMC's primary role is to maintain a register of all those who are qualified as medical practitioners. That duty provides an assurance to the public that all registered doctors are qualified to practise. The GMC must assure itself that those admitted to the register are competent. It must also ensure that those on the register remain fit to practise. As the Merrison committee put it in 1975,
the maintenance of a register of the competent is fundamental to the regulation of a profession".
That remains as true today as it did in 1975, or, indeed, at any time since the passing of the original Medical Act in 1858. In essence, that is the subject of today's debate. How can the GMC ensure that doctors on its register have maintained their competence in a fast-moving medical environment and continue to meet the high standards of performance set by the medical profession?
The Bill does that by making important changes to the professional regulatory powers of the GMC. New professional performance procedures will be introduced; and two new statutory committees—the assessment referral committee and the committee on professional performance—will be created to implement the new procedures. We propose to establish those new procedures in a way that is consistent with the principle that self-regulation is the most appropriate way for the medical profession to be governed and that it is the best way to maintain the high standards that the public rightly expects of its doctors, and which the great majority of doctors achieve. That principle is both long established and cherished by the profession, and it is one which the Government support.
The value of self-regulation has been further demonstrated by the fact that it was, as I have said, the GMC itself that first identified the gaps in its powers and took the initiative in asking the Government to introduce the measures that are now set out in the Bill. The professional performance procedures proposed will go a long way towards plugging the gap. They will do so in a novel way. The procedures are not there to ascertain whether the doctor is guilty of a particular instance of alleged deficiency. They do not offer individual redress for patients' complaints, although patients will receive feedback.
The Bill aims to achieve what many people say that they want when they complain: to see that something is done to stop a similar incident happening again. The purpose of the new procedures is to inquire into the underlying causes of any problems that have been


reported. The GMC will consider whether the matters complained of, particularly where there has been a series of complaints, show a pattern of serious deficiency in the standard of the doctor's professional performance. If that is the case, the doctor will be asked to have his performance assessed by a panel independent of the GMC, which will include two doctors of the same specialty plus one lay doctor. The panel's key role is to identify whether there are any significant weaknesses in the doctor's performance, to discuss those with the doctor and to give advice on what the doctor can do to remedy the position.
What I have described is initially a consensual process. The aim of the Bill overall is remedial. Wherever possible, we want expensively trained doctors to be put on the right track. However, it is important that the procedures work where the doctor does not consent. Therefore, much of the Bill provides for where the co-operation of the doctor is not engaged or where it breaks down for various reasons. It also provides for a doctor's registration to be suspended or for conditions to be attached to registration if that would be in the public interest and would help to protect the doctor's patients.

Mr. Gareth Wardell: I support the Bill and, as the Secretary of State said, I am a member of the GMC. While a doctor is suspended and going through the procedures, will his registration on the GMC's register show that he is suspended, so that the general public can be aware of that?

Mrs. Bottomley: I understand that while the inquiry is under way, the register will show the suspension. I well understand the hon. Gentleman's concern that patients' interests should be safeguarded in that way.

Dr. Charles Goodson-Wickes: At the risk of sounding patronising, I wonder whether I could help my right hon. Friend. I imagine that by the time such a position was shown on the register, it would not fall within the cycle of that register's publication.

Mrs. Bottomley: That is true, but it is important that the information is available to those who wish to have access to the register.

Mr. Wardell: I am grateful to the right hon. Lady for giving way again. I am concerned that under part 3 of the procedures, the doctor could go round and round in a loop, for a period even exceeding three years. Despite what the hon. Member for Wimbledon (Dr. Goodson-Wickes) said, as I understand the procedures it is possible for a doctor to be retrained and continue to be retrained for quite a lengthy period. Would the Secretary of State be happy to put some limit on the period that a doctor can keep going round the loop?

Mrs. Bottomley: The hon. Gentleman makes a good point, which can be explored further in Committee when he will no doubt wish to develop his argument.

Dame Elaine Kellett-Bowman: What about the engagement of locums? Will people be warned so that they do not inadvertently engage such doctors?

Mrs. Bottomley: That is something that the doctor concerned would need to discuss with his employers—either a trust or the family health services authority,

depending on the doctor's circumstances. Much would depend on the seriousness of the matters under consideration.
As I have said, it is important that we are prepared not only for cases where there is consent, but for those where the doctor does not consent. The Bill provides for cases where the co-operation of the doctor is not engaged or where it breaks down for various reasons. It also provides for a doctor's registration to be suspended or for conditions to be attached to the registration, if that would be in the public interest and would help to protect the doctor's patients.
I commend to the House a short paper prepared by the GMC on its proposed performance procedures. It explains step by step how the system works. A number of copies have already been placed in the Library. I shall, however, go through the course of a case where the doctor agrees to the process and then explain in more detail how the system will cope with an unco-operative doctor. I am aware that in Committee it will be possible to scrutinise that journey in even greater detail. The GMC will identify doctors whose performance is seriously deficient through information sent to it: for example, through patients' complaints, information from other doctors, or cases referred following NHS service committee hearings. Overall, the GMC expects that the number of doctors subject to assessment under the new procedures will be in the order of 100 to 150, of whom 50 to 75 might be subject to remedial training or sanction.
Anyone can bring information about a doctor's performance to the GMC's attention. The doctor may be working in the NHS or private practice. The informant will not have to be personally involved in the matter. For instance, surgeons who have to rectify the mistakes of another doctor—perhaps of cosmetic surgery—would have a duty to report those matters to the GMC.
I am pleased that the GMC has made the position clear in its Blue Book entitled "Professional Conduct and Discipline: Fitness to Practice". It says:
It is any doctor's duty, where the circumstances so warrant, to inform an appropriate person or authority about a colleague whose professional conduct or fitness to practise may be called into question or whose professional performance appears to be in some way deficient.
That is an important message and one that is often difficult to have fully accepted and used throughout the service, but all professionals have an obligation to be alert and vigilant about their colleagues' quality of performance.
Employing authorities and trusts will be aware of poor performance from a variety of sources. It is important that the NHS complaints and disciplinary procedures, based on the Wilson review, which we have only recently announced should be carried out properly. In addition, employers should consider whether to refer the matter to the GMC. The GMC and the employer have separate and complementary roles. Some problems will be dealt with entirely by the employer; in some cases, only the GMC will be able to act, and in a minority of cases both will need to take action.
Patients or other relatives who are concerned that other people may be suffering from the same poor treatment as they experience may wish to report it to the GMC. The information given to it will have to be well founded and


to give it grounds for considering that the incident is not just a one-off, but an indication of a pattern of poor performance which should be investigated further.

Mr. Jim Cousins: Does not the Secretary of State's remark imply that a single incident can never rank as being serious enough to challenge professional performance? Her last remark seems to imply that repetition is the centre of the argument, whereas a single incident, if it were serious enough, could be serious within the terms of the Bill.

Mrs. Bottomley: If the incident were serious, it might be considered as part of serious professional misconduct, but we are considering here a one-off incident that is not sufficiently serious for the existing procedures, that is of a lower order, and that therefore may be part of a continuous pattern of poor performance. The aim of the proposal is precisely to fill that gap.
Anyone who has given information to the GMC will be kept informed of the action taken at various stages of the process. They will, of course, be notified of the outcome of any hearings by the committee on professional performance.
Whatever the source of information, the GMC must take the matter seriously. The first step is to consider under which procedure the case should be considered. This relates to the point made by the hon. Member for Gower (Mr. Wardell). Should the case be considered under conduct, health or professional performance? Whatever the case may be, the matter will be considered by a screener who will be a medically qualified member of the GMC. In cases of alleged poor performance, the performance screener will be empowered to investigate the background of the case, and to consider whether a prima facie case exists of serious deficiency in the doctor's professional performance. The informant may be asked to make a sworn statement about the allegation.
The screener may wish to take advice from an expert in the same speciality as the doctor under review before deciding what action needs to be taken. The screener will either invite the doctor to undergo an assessment or conclude that no action should be taken. In that case, a lay screener is also involved in deciding that no action is required.
If further information uncovered by the screener suggested that there were health reasons underlying the doctor's poor performance, the matter could be remitted to the health screener under the health procedures. Where no formal action is proposed under the GMC's fitness to practise procedures, the doctor may be invited to comment informally on the information received. Any reply would then be sent to the informant.
Where formal action is proposed, the screener will advise the doctor of the information received by the GMC and invite the doctor to undergo an assessment. If the doctor does not agree with the screener, the matter will be considered by the assessment referral committee. That committee's role is to provide an appeal forum for the doctor who does not agree with the decision of the screener that he should undergo an assessment. It ensures that contested decisions that may affect the doctor's future are not taken by one GMC member alone.
Once the committee has considered written submissions from the doctor or given the opportunity of a hearing, it may either direct that the doctor undergo an assessment or decide that there is no prima facie case of seriously deficient professional performance and close the matter. If the committee confirms the screener's decision, the screener will arrange for the assessment.
If I may, I shall go into a little more detail of the assessment process. It will be carried out by an assessment panel which will consist of two medical practitioners from the same specialty as the doctor and a lay person. None of these panel members will be members of the GMC. They will be drawn from lists of specialists nominated by the professional bodies, including the royal colleges and the British Medical Association. Lay members will be nominated by non-medical bodies. The procedures to be followed by the panels will be set out in rules made by the GMC, approved by the Privy Council and laid before Parliament. The panel will also be given guidance and training on how to carry out the assessment process.
As the House would expect, the GMC has already started work on some of the details involved. In 1993 it appointed Professor Lesley Southgate, a distinguished professor of general practice, to begin developing the assessment procedures in co-operation with experts from each of the specialties. The assessment programmes will underpin the new procedures in the Bill. To give the House a flavour of what it involved, I shall describe her work in a little more detail.
Professor Southgate has pilot-tested with volunteers on several occasions her system for assessing GPs. The assessment consists of a review of a doctor's records, a written test of his or her knowledge, observing the doctor in practice, discussing performance with selected third parties, a test of clinical skills and a face-to-face interview, which includes a review of one or two of the doctor's recent cases. Those are certainly rigorous procedures which the GMC is looking to extend into the various specialties. Pilots are under way, for example, for assessing the performance of anaesthetists.
In as much as the Government's policies have encouraged those trends, I make no apology. The health service exists for its patients and to provide the latest and the most modern care. However, it is right to recognise the extra pressure that this puts on doctors. Describing how the GPs in the trial had reacted to her grilling, Professor Southgate stated:
they found it stressful but a great thing once done".
Perhaps that is a fair assessment of many of the changes now taking place in the national health service.
At the end of the assessment process, a report will be prepared by the chairman of the assessment panel and sent to the doctor, who will be invited to take on board its recommendations. The doctor will be asked to confirm his acceptance and compliance with the recommendations. If he does not, the matter will be referred to the committee on professional performance.
If the doctor agrees to take remedial action, a period will be allowed for the necessary training or other remedial action and for it to be put into practice before a second assessment is carried out. After this initial period of remedial action, the assessment panel will assess the doctor's progress. If the doctor's level of performance has been remedied, the case will be concluded. Where there


has been some progress and further action might be productive, the doctor may be allowed to undertake a further period of remedial action.
If the doctor does not appear to have benefited at all from this remedial period, there may be the opportunity to ask for the voluntary removal of his name from the register. If the doctor wishes, the matter will be referred to the committee on professional performance. Alternatively, the screener will either arrange a further assessment or refer the matter to the committee on professional performance.
It is proposed that a doctor should be allowed to go through the remedial process up to three times—this relates to the point made by the hon. Member for Newcastle upon Tyne, Central (Mr. Cousins) about how long the matter can be perpetuated—but it is not proposed that the number should be prescribed in the rules. The doctor will have the right to have the matter determined by the committee on professional performance at any time following the first assessment.
The committee on professional performance is, indeed, the committee of last resort. The General Medical Council hopes that most cases will be resolved during the consensual part of the procedures. The matters will come to the committee, however, in a number of ways: first, where the screener on receiving an assessment report considers that the doctor's performance is irremediable and the doctor has not agreed to the voluntary removal of his name from the register; and, secondly, where the doctor has not co-operated right from the start or has indeed withdrawn co-operation during the process. The doctor may, for instance, have been directed to undergo an assessment by the assessment referral committee and refused to do so.
Thirdly, the matter will come before the CPP where the doctor has undergone an assessment but is not prepared to agree to the required conditions. The doctor may refer the case to the committee. If the screener cannot get the doctor to agree to the conditions, the case must be referred to the committee. The final way is following a period of remedial action and reassessment, where there has been no significant improvement in the doctor's performance.
The procedures to be followed by the committee will be set out in rules. If the doctor has not undergone an assessment, the committee may require it. If he refuses or has failed to co-operate in some other way, the committee will be able to impose sanctions. Those include suspension or attachment of conditions to registration as appropriate. Where the committee, however, finds that the doctor's professional performance has been seriously deficient, it will be able to suspend the doctor or attach conditions on registration. For example, the doctor may be required to practise under the supervision of another doctor or refrain from performing a particular clinical procedure.
Where the committee considers it necessary for the protection of the public, it may impose immediate suspension of the doctor. The Bill will ensure that the doctor has appeal rights, which are similar to those which exist under the health procedures.

Mr. John Gunnell: In the hearings held by the General Medical Council at the moment, which are obviously, in general, about professional misconduct, the press are normally present. I have seen nothing in the Bill to show whether the press

should or should not be present or whether the decision at which the committee arrives will be made public. At this stage, is the knowledge of the procedure and the result of the hearings entirely within the remit of the GMC?

Mrs. Bottomley: It is the intention that such hearings should be held in private—certainly for the first two years. That is subject to review and, indeed, it is also possible, with agreement, that such matters could be heard in public. Again, the committee may wish to discuss that in more detail. The proposal that for the first two years the procedures are held in private while they are under way has considerable merit.
As the hon. Member for Morley and Leeds, South (Mr. Gunnell) will know, there are always difficulties about how freely, frankly and openly some witnesses are prepared to speak in the full glare of publicity and the press. There is often a tension between wishing matters to be fully open, but knowing that witnesses are somewhat inhibited because they know that every word that they say is likely to be read in the newspapers the following day. The proposal is a considered preliminary response to the new procedures and I am sure that it will be subject to review and careful scrutiny.
If I may turn to the Bill itself, the House will be pleased to know that it is short; it has six clauses. It will give the GMC the necessary powers to make the new procedures work where a doctor is not co-operating and the powers to impose sanctions. Much of it amends the Medical Act 1983. I have placed in the Library a revision of the relevant provisions of the 1983 Act as they would appear on consolidation of the Bill in that Act. The details of the procedures to be followed by the GMC will, as I have said, be in rules.
Clause 1 deals with the powers of the committee on professional performance, which has been described as the sanctions committee. It will be empowered to impose conditions on, or suspend, a doctor's registration. It will do so where the doctor's standard of professional performance is found to have been seriously deficient and the committee considers that sanctions should be applied to protect the public.
It is not the intention that the sanctions should be punitive. They are part of improving the service to patients. Although, in the worst cases, a doctor might be suspended indefinitely, the name will not be erased—doctors will not be struck off. That is a fine, but an importance distinction to make, as the intention of the procedures is remedial. The committee can also impose sanctions if a doctor has failed to co-operate with the assessment process.
Clause 2 covers cases in which a doctor's failings may be considered to be beyond remedial action. The doctor may be asked to consider voluntary removal from the register. Again, the doctor would not be struck off, which has disciplinary overtones. The doctor might be falling behind with the latest medical techniques, which have now become the accepted techniques. The doctor might realise that it is time to call it a day and ask to be removed from the register.
We realise that unscrupulous doctors might use the provisions of voluntary removal to frustrate active consideration of their performance. To minimise the risk of the misuse of the provision, clause 2 also provides for


the matter to be referred back to the relevant committee for approval, should the doctor apply at a later date for his name to be reinstated on the register.
Much of the meat of the Bill is contained in the schedule, which gives the General Medical Council the power to make rules, to set up the assessment referral committee and the committee on professional performance, and to provide for the constitution and proceedings of the two committees and the assessment panels. The rules will also give the committee on professional performance powers to impose sanctions if a doctor does not co-operate, and to give the doctor a right of appeal to the High Court where such sanctions have been made.
The assessment panel will be given powers to inspect medical records and, where entry to professional premises is likely to be denied, it will be able to apply to a magistrate for a warrant. It will be an offence for a person to obstruct the work of an assessment panel.
The House will appreciate that the procedures introduced by the Bill are somewhat complex. Its aim is simple enough, however. It is a further measure designed to improve the quality of service available to patients from the national health service, and indeed from private practice, and to ensure that they continue to enjoy the highest standards of care from our doctors. It is significant that the Bill has come from the medical profession. It is a sign of how clinicians are responding to the greater expectations made of them and recognising the legitimacy of challenges against the performance of individuals.
There was a time, perhaps, when the profession would not have been so amenable to such a proposition. We can all understand the reasons. The process of scrutiny and review is not always comfortable for doctors, even for those who have nothing to fear from its results. It is, however, an essential part of a service in which we are determined to put the needs of patients first and to maintain their confidence in the service that they receive.
What is important is that the procedures are effective, constructive and fair to staff, as well as to patients. The measures in the Bill fit well with those objectives. They are part of our commitment to a higher-quality health service of which we can all be proud.
The introduction of the Bill to Parliament gives a clear signal to doctors whose performance is not up to standard that the remedy is in their hands—it is a case of physician heal thyself. I commend the Bill to the House.

Mr. Nicholas Brown: I congratulate the Secretary of State on coming to the Dispatch box voluntarily—I was beginning to think that she did not like coming here—and so soon after her interview with Mr. Dimbleby.
You will recall, Madam Deputy Speaker, that just before the recess, the House—not just the Opposition, but members of the Government—was demanding time to debate the crisis facing the hospital service, especially in London. I should have thought that, now that the Conservative rebels have come back to the fold, it would be safe for the Government to find time for such a debate,

but they tell us that there are pressures on parliamentary time. They have found a whole day to debate this Bill, however.
The principles that underpin the Bill are not controversial between the parties. The parliamentary Labour party supports the Bill, as do the minority parties, I understand. There is a consensus behind the principles that underpin it. My right hon. Friend the Member for Derby, South (Mrs. Beckett) promised it a fair wind through the House in the debate on the Queen's Speech. Indeed, in 1993, my hon. Friends the Members for Newham, South (Mr. Spearing) and for Strathkelvin and Bearsden (Mr. Galbraith), among others, tried to introduce a Bill designed to achieve the same objectives, so the Secretary of State is perhaps making too much of the courage and determination that the Government are showing by bringing this legislation before us.
The Government Whips seemed nervous about exposing the Secretary of State to debate in the House. One of the first—

Mrs. Virginia Bottomley: I have no idea what the hon. Gentleman is talking about. On the first day back after the recess, we had a very successful Health Question Time. All the Government spokesmen wiped the floor with the Opposition spokesmen, who were described in the press as hiding like frightened rabbits, devoid of policy. They were simply exposed for their empty cupboard by all the journalists.

Mr. Brown: What press?

Mrs. Bottomley: The Guardian, The Economist, the Observer and the Health Service Journal. I have never known such a slaughter of the Opposition for their lack of policy on the health front—timid, frightened and devoid of policy, Madam Deputy Speaker. I do not think that I need to say more.

Madam Deputy Speaker (Dame Janet Fookes): Certainly not. That was quite a long intervention. Before we go any further, perhaps we could turn to the principles of the Bill, which is the business before us.

Mr. Brown: I was about to debate the principles of the Bill when I generously, in a bipartisan spirit, gave way to the Secretary of State and allowed her to mislead the House. The truth of the matter is that, when I asked the Minister of State for the estimated cost for local pay bargaining at Health Question Time, he spoke at some length in response, but never gave the House the estimates. No doubt he would describe that as professionalism on his part, but I think that the House understood what he was not telling us.
Let me return to the point that I was going to make before I so generously—but perhaps wrongly in view of your strictures, Madam Deputy Speaker—gave way. One of the first duties that I and my right hon. Friend the Member for Derby, South had when we were appointed to our new Front-Bench responsibilities was to meet representatives from the General Medical Council. They urged this Bill on the parliamentary Opposition and said that the Government had told them two things—that they could have the Bill, but that there was not enough parliamentary time for it and so they had to get the agreement of the Opposition to ensure that it received a fair wind through the House.
How can anyone truthfully say that, in this Parliament, there is not the parliamentary time for a Bill of this nature, Madam Deputy Speaker? We have enough parliamentary time in this Parliament to revise the entire criminal code. One could not possibly truthfully say that there is a lack of parliamentary time. No doubt the reason why we have a full day's debate on this relatively non-controversial matter is that the Government want to avoid debating more controversial matters. The Bill and its underpinning principles are supported by the parliamentary Labour party.
We are being invited to discuss what is effectively professional self-regulation. In the light of some of the decisions that we had to make last week, it is ironic that we are discussing another body's methods of self-regulation. In view of what many people think about the ethics of our profession, it is ironic that we are discussing the ethics of a profession that is held in higher esteem by the general public than ours.
The core of the Bill is self-regulation. Only the General Medical Council has a universal power to restrict a doctor's practice, or bar him or her from practice altogether. No national health authority or trust could prevent a doctor from taking up employment elsewhere, either in the health service or privately.
The General Medical Council is a statutory body. It is independent of Government and receives no public funding. It is financed by a levy on registered doctors and, interestingly, is answerable to the Privy Council, not to the Secretary of State. As the Secretary of State told us, the GMC currently has two sets of disciplinary procedures. The first deals with conduct—doctors whose behaviour suggests that they may be unfit to practise. It can deal only with single acts of serious professional misconduct, which was the point made in the intervention by my hon. Friend the Member for Newcastle, upon Tyne, Central (Mr. Cousins). The second set of disciplinary procedures deals with doctors whose health may affect their fitness to practise.
To date, unless it has been found that a doctor's fitness to practise has been seriously impaired by ill-health, or unless a doctor has been found guilty of serious professional misconduct or convicted of a criminal offence, the GMC has no power to act against an individual practitioner. That is a substantial cause of public disquiet. The profession's failure to regulate itself because it does not have the powers to do so is unfair on complainants and, of course, on those charged with the supervision of the profession.
In 1993–94, the General Medical Council received 1,626 complaints. Of those, only 195 made it beyond the preliminary screeners and only 83 cases were referred to the professional conduct committee for investigation. Clearly, that is unsatisfactory and it is right that we should consider remedial legislation.
The reason for not proceeding with complaints is often that the General Medical Council's powers are too restricted. That is the issue with which the Bill seeks to deal. The Bill will add a third set of procedures, which will provide powers to discipline doctors whose general performance over a period of time is revealed as seriously flawed. The Bill will allow the GMC to exercise discipline
in those situations where a doctor's pattern of professional performance appears to be 'seriously deficient'—in other words, so blatantly poor that patents are potentially at risk".

Before dealing with some of the issues of detail, which we shall explore in Committee if we cannot get a response from the Minister tonight, may I raise a procedural point? The Order Paper contains a proposition to refer the Bill to a Special Standing Committee and I understand that the question can be put forthwith at the end of the debate. The idea is that, instead of the normal adversarial way of proceeding in Committee, where one side puts its inquiries and it is hoped that the Minister or Secretary of State, if she is to serve on the Committee—it would be nice to see her do so—answers the questions. The alternative procedure is to sit in a forum where specialist witnesses—presumably from the General Medical Council, the British Medical Association and patient groups—can give their informed opinions to the Committee, which, having heard their advice, can then make decisions on the issues.
In principle, that procedure has much to recommend it. When I was a member of the Labour party's Treasury team, I argued that the Finance Bill could be better dealt with if some of the specialist issues were taken in such a forum rather than in Standing Committee. I do not know the Government's attitude to the procedure, but if they decide to adopt it for a Bill that is, in principle, not contentious, in a spirit of consensus and co-operation the Opposition will co-operate fully with it. I hope that, in so saying, I put a persuasive argument to the Minister of State who, I suspect, will take the Bill through its Committee stage.
We shall want to explore issues such as the Bill's structure. It has been argued that it might have been better to adopt a structure that was, essentially, put forward in the Bill introduced by my hon. Friends in 1993, which would have modified the rules for serious professional misconduct in such a way that serious under-performance would be deemed to be serious professional misconduct, rather than to introduce a third new procedure. Although there are arguments on both sides, I prefer to explore the rights and wrongs of the two different ways of proceeding with professionals than to argue it out with Ministers in an adversarial setting in Committee. The Minister will, no doubt, argue that what has been done in the Bill is right and could not possibly be done in any other way. I am not sure that that is true and I should like to listen to professional specialist opinion.
I should also like to explore with the Minister whether it is realistic to think that a doctor whose performance has been so persistently bad that he is putting patients at risk could ever be reformed by retraining. The Bill puts a great deal of emphasis on training and retraining, but there will come a time when no amount of retraining will achieve the required result and, sooner or later, someone will have to say that. I want assurance that the procedures will do so.
The assessment referral panel—the body that can require doctors to undergo assessment—will meet in private. The Secretary of State said that there were good reasons for that, and I understand them. However, it is an important principle that justice, as well as being done, must be seen to be done. Complainants will have no right to ask for a public hearing and I should like to test the arguments on whether that should be so. Obviously, I understand what the Secretary of State said, but countervailing arguments deserve to be explored.
The Secretary of State rightly paid tribute to the three Members of the House who serve on the GMC as lay members. I suspect that it is not widely known that serving in that capacity involves all three of them in a lot of hard work. Their contribution to public service should be commended and I endorse what the Secretary of State said.
The Bill will require an increasing lay involvement in the General Medical Council's affairs. The Patients Association, among other organisations, has properly expressed concerns about the training of lay members of the GMC assessment panels. It is important that lay members are properly trained and have experience in handling patients' complaints. The history of the involvement of the laity under the Conservative party's management of the national health service has not been untainted or unencumbered with criticism. I hope that we can achieve a laity for this function which is absolutely beyond criticism or the suggestion of being tainted with party-political partisanship. That could not be said about the laity in the rest of the national health service.
The Committee will want to explore with the Minister its concerns about the tremendous power of the initial GMC screener to sideline serious complaints, or at least to assess their importance. The screener will have an important role in either accelerating complaints through the complaints procedure or delaying consideration of them. Justice delayed is justice denied, which is precisely the issue that we are trying to remedy. So some attention to the role of the screener acting on behalf of the GMC is important.
The Secretary of State said that the Bill allows voluntary removal from the register. I wonder whether that will allow errant doctors to remove themselves from the register rather than face up to the charges brought against them. If they behave in such a way, will they then be able to request reinstatement later? I should like to explore further with the Minister precisely how voluntary removal will interact with the other proposed procedures.
The Patients Association is not alone in suggesting that a system of regular compulsory reaccreditation should be introduced as an effective means of weeding out incompetent doctors. I shall not give a view on that proposition now, but that idea is worth exploring, alongside the other provisions in the Bill. Whichever arrangements we adopt for the Committee, I hope that we will be able to do just that.
The BMA has expressed concern that, under the new system, general practitioners will have to pay for their own retraining. The Opposition want to explore the cost implications of that with the Minister. I believe that a possible inequity could be created if GPs have to pay for their own retraining while doctors who are employed by hospital trusts, or junior doctors employed by the regional department of the Department of Health—if I understand the Health Authorities Bill aright—will have their retraining paid for them.

Mr. Gareth Wardell: I am concerned about equivalence. To what extent does my hon. Friend agree or disagree that doctors are being considered differently in terms of their performance in comparison with the way in which other professional bodies consider the performance of their members? Does my hon. Friend agree that the Bill could be judged overgenerous and to

be bending over backwards to the medical profession, given the extent to which the GMC may go to protect doctors from removal from the register? That is at odds with the way in which the performance of teachers, lawyers, accountants and other professionals is dealt with. Is my hon. Friend happy that a even hand has been dealt across the professions?

Mr. Brown: My hon. Friend, who speaks from experience as he serves on the GMC, makes an important point. I am absolutely certain that the principle underpinning the Bill is right. We are introducing a new procedure, so only time will tell how it works in practice. I would not want to do the Bill an injustice before giving the provisions contained in it a chance to operate. I accept, however, that the Bill creates an anomaly, given the way in which one professional group is treated as opposed to another.

The Minister for Health (Mr. Gerald Malone): In response to the hon. Member for Gower (Mr. Wardell), as I understand it from the GMC, it is not the purpose of the legislation to seek to remove doctors from the register. That is the sanction of final resort. I am sure that the hon. Gentleman is aware that the purpose of the Bill is to provide proper opportunities for retraining so that matters can be put right and people can be put back on the proper professional course. I am not certain whether one can make an analogy across the professions. I know from my own profession—at least when I practised it 10 years ago—that there was a continuing system of post-qualifying education. That example may serve as an analogy, but it need not be the case that the professions are on all fours with each other.

Mr. Brown: The Minister seems to have taken the point made by my hon. Friend the Member for Gower (Mr. Wardell) and put it back to him. I shall say something later about the anomalies that the Bill is creating between different professions inside the health service. It should be possible to obtain a commitment in principle from the Government at least about the professions inside the NHS.

Mr. Gunnell: The argument put by my hon. Friend the Member for Gower (Mr. Wardell), who serves on the GMC, is strengthened by our call for a general social services council and a general teaching council, which would run on the same lines as the GMC. We believe that the GMC functions well and that it would be to the benefit of other professions and the public if similar arrangements applied to teaching and social work.

Mr. Brown: My hon. Friend is undoubtedly right. The Bill is underpinned by the concept of professional self-regulation. The Bill places emphasis on retraining rather than immediate disciplinary sanctions. The Secretary of State and I have expressed some concern, however, about whether the emphasis on retraining, further retraining and yet more retraining might not be overgenerous to the medical profession. It would be better to wait to see how the Bill works in practice rather than fail to give it the fair wind it was promised in the Queen's Speech.
The Minister spoke about the internal arrangements governing his own profession. As I understand it, an allowance is paid for the postgraduate education of GPs. They receive £2,000 a year for undertaking 30 hours or


more of approved study a year. Some concern has been expressed about how that system operates in practice, and whether there are any sanctions against doctors who do not undertake that 30 hours of study. I should like to explore that in Committee, because I do not expect the Minister to offer an opinion on that on Second Reading.
The United Kingdom Central Council for Nursing, Midwifery and Health Visiting investigates cases of misconduct. The GMC, however, only investigates cases of serious professional misconduct. The Bill will allow it to consider cases of seriously poor performance. The nurses' professional body will, therefore, still have a wider remit than the GMC. As my hon. Friend the Member for Gower has said, the Bill creates an anomaly between the powers of the GMC and the powers of other health care professional registration bodies.
The GMC currently investigates cases according to the key test of serious professional misconduct—to be amended by the Bill—as do the General Optical Council and the General Dental Council. The nurses council investigates cases of misconduct, so it obviously adopts a wider criterion than that adopted by the GMC. The Council for Professions Supplementary to Medicine investigates cases according to its test of infamous conduct in a professional respect. I suspect that it is difficult to prove that and that that test is overdue for review. The osteopathic and chiropractic organisations investigate cases of unacceptable professional conduct. I understand that the Royal Pharmaceutical Society investigates cases of misconduct, but I may be wrong about that. I am, however, fairly certain about the other bodies that I have mentioned.
The practice adopted by the respective councils is anomalous, so when the Minister replies to the debate perhaps he can tell us whether it is the Government's intention to introduce legislation so that the procedures governing other health care professional registration bodies are brought into line with those now proposed for the GMC. It seems anomalous that one professional body should decide to launch an investigation according to one test, while other professional bodies that deal with related health care functions act according to a more serious test. I am sure that the Minister has given that matter extensive consideration, or at least someone has, and that the hon. Gentleman will have a response ready for the end of the debate.
Perhaps it is right to give the last word to the chairman of the BMA; after all, he represents health care professionals. In September 1993 he said:
We need to retain the full confidence and trust of our patients. But we must remember that the Government can play a significant part in all this by reducing stress, raising morale, instilling realistic patient expectations, listening to the profession's concerns about the reforms and ensuring a consensus approach to the problems facing us.
I endorse every word of that.
It is ironic that on a day when the BMA, representing junior doctors, wins a case in the courts concerning the stress connected with junior doctors' hours of work, we are considering legislation on professional standards. It does not sit easily for the House to expect doctors, especially junior doctors, to work very long hours and still, at the end of those long hours, perform to the highest professional standards. The fact that on the whole they do so is a great credit to the profession.
The ethical base of the national health service is its foundation and its enduring strength. It is its ethical base that has enabled it at least to come through, if not wholly to survive, the Government's health reform agenda. I support the Bill, but perhaps not quite in the same spirit as the Secretary of State.

Dame Jill Knight: I have read the Bill, and the papers pertaining to it, with great care, and I have several questions in my mind about the effects of the legislation. We all rely on the excellent service that we receive from the research department of the Library, and I turned with great interest to the research paper on the Bill that that Department produced.
On page 4 of the paper I saw encapsulated the reason for the Bill:
To date, unless it has been found that a doctor's fitness to practise has been seriously impaired by ill health, or unless a doctor has been found guilty of serious professional misconduct or convicted of a criminal offence, then the General Medical Council has no power to act against an individual practitioner. In particular, the GMC is not at present able to act either where a doctor's professional competence in general is shown to be inadequate, but no single act has been committed which could constitute 'serious professional misconduct', or where a single act has indeed been committed, but is not judged to constitute 'serious professional misconduct"'.
"So," thought I, "that is what the Bill is about, is it? I see. That is very interesting." I agreed that there was clearly a need for the Bill. However, when I turned to the Bill itself, twice in the first two paragraphs of the explanatory and financial memorandum I saw the phrase "seriously deficient". So the measure refers not to a slight problem but to practice that is seriously deficient.
As every Member of the House with any experience knows, the nub of a Bill is always in clause 1—and in the first few lines of clause 1 the term "seriously deficient" appears again. So I come to my first question: how is it to be decided whether a performance is "seriously deficient", and is not such practice covered to some extent by the GMC already? If so, does the Bill not seek to do something that will not happen?
The hon. Member for Newham, South (Mr. Spearing) deserves great credit for consistency, in that he has worried about the problem for a long time and has introduced no fewer than six private Members' Bills on the subject. The hon. Gentleman has highlighted one instance that made him anxious—the case of a child in his constituency who had died of meningitis after his GP could not be bothered to examine him. Apparently the GMC found the facts to be proven but, amazingly to me, it felt that the charges did not amount to serious professional misconduct. If that is not serious professional misconduct, it is difficult to think what would be.
There is clearly a case to be made that we should go wider than the present powers of the GMC. No doubt we shall hear later the views of my hon. Friend the Member for Chislehurst (Mr. Sims) and of the hon. Member for Gower (Mr. Wardell); they are both members of that body. But there is certainly a case that we should go further than the GMC can go at present.
However, I am worried because the Bill confines its attention to "seriously deficient" performance, and we still have to ask whether it is considered seriously deficient if


a doctor feels too busy and cannot be bothered to examine a patient, who subsequently dies. My first question is: on what ground do we decide what is seriously deficient?
Would the doctor's behaviour have to result in death? Bearing in mind the case that I have described, perhaps that criterion would not be enough. Or, as some of the community health councils would have it, are there many lesser evils being perpetrated by doctors that should be dealt with at once? Not long ago, a questionnaire was sent to patients of a practice asking whether the magazines in the waiting room were up to date or whether they were dog-eared and had been used too much, and also whether the car park was sufficient for all the patients. I would not call failings in that respect seriously deficient, and I am sure that they are not what the Bill is intended to address. One sometimes needs to watch what the community health councils get up to with the money that they are allocated.
I wonder whether language inability would count as seriously deficient. A great many doctors have come to us from other countries, and there is no doubt that they serve the health service well. But patients often need to describe their condition using nuances of language that a doctor insufficiently competent in the English language cannot comprehend. Will that come under the same heading?
Page 7 of the Library research document tells us that the procedures
will not be confrontational like the conduct procedures, but will rather resemble the health procedures, in which only cases where a doctor has refused help actually go before the formal Committee.
I should like to know what that means, and how cases will come before the committee.
We have heard a lot about retraining, and I understand that to mean retraining for doctors who are providing a seriously deficient service. But I am not sure whether retraining will help in the cases that some of us have in mind. Suppose, for instance, that a doctor were, as we describe it in the House, "tired and emotional". Suppose that he did not treat his patient properly because of his weariness and his emotional state—helped, perhaps, by gazing upon the wine when it was a little too red. How could one retrain someone in a case such as that?

Mr. Sam Galbraith: It might help the hon. Lady if I said that perhaps such a case would be referred to the health committee, not the professional competence committee.

Dame Jill Knight: I am grateful to the hon. Gentleman, who knows, as a medical man, some of the problems that confront us here. However, I am trying to find out precisely what the Bill will do, precisely which cases it will affect and the precise way in which those cases will be handled.
When I first read the Bill, I wondered—and I hope that I may be right about this—whether, if the object of the Bill was achieved, it would avoid, or at least lessen, the ruinous and expensive business of litigation involving doctors. That is growing, without any doubt, and the implications are extremely serious. One has only to consider the United States to be aware of how very damaging it is for members of the medical profession. It is damaging because of the huge costs of medical

insurance. I understand from friends of mine in the medical profession that that is now beginning in earnest in Britain. Let no one here suppose that I am over-emphasising that.
I am assured that American doctors must set aside an enormous sum in insurance payments to indemnify themselves, and things are already moving in that direction in Britain. Slick lawyers in America actually follow ambulances, or comb the sensational press for horror stories of patients, who may perhaps be used to start litigation.
In addition to cost, there is an extra burden of worry for the doctor when the threat of litigation hangs over him. Does the call in the middle of the night really involve a serious condition? Mrs. Jones has phoned for no real reason on numerous occasions. Will she sue me if I do not get up, get dressed and go and see her now? How am I to know how bad her condition is?
It is in the interests of good doctors, who make up the overwhelming majority of the profession, that machinery should be in place whereby the tiny minority of bad doctors may be brought to book for wider reasons than those that are available at present. After all, doctors have an immense power over people's lives, and we should not forget that. We should recognise that what they say to their patients and the way in which they treat their patients can have a wide effect on patients' lives.
Subsection (9) of clause 1 states:
While a person's registration in the register is suspended by virtue of this section he shall be treated as not being registered in the register notwithstanding that his name still appears in it.
I read that two or three times, with increasing puzzlement. The name will not be removed from the register, but one will have to pretend that it is not there. How will people know that it is invisible when it is visible? That is a trick that I have not yet managed to solve.
I realise that it might be jolly expensive to remove names and replace them after a time, but surely we could have little stickers or something. Let us suppose that a doctor has been removed from the register technically, but not actually, and that he goes away and applies for a job as a locum, hundreds of miles away. When the doctors who are considering employing him consult the register and find that his name appears on it, how will they know that he is not really there, if he does not tell them?
I do not understand how that will work.

Mr. Gareth Wardell: I believe that the hon. Lady and I share anxieties regarding clause 1(9), because it is strange that it says:
While a person's registration in the register is suspended by virtue of this section he shall be treated as not being registered in the register notwithstanding that his name still appears in it.
As the hon. Lady rightly says, unless some sign is given that will be understood by anyone who has access to the register, it may be difficult to know the status of that doctor.

Mr. Galbraith: rose—

Dame Jill Knight: Does the hon. Gentleman wish to intervene?

Mr. Galbraith: I understand that, when one seeks a job, one must oneself provide evidence of one's registration. It is not checked up on. That would not be


provided to one by the General Medical Council if one was not registered, even though one's name was on the register.

Dame Jill Knight: That may be the case. Nevertheless, I do not quite understand how it would work in the case of a doctor who wanted temporary employment while perhaps he was debarred from practice in his own part of the country. I am still by no means sure that that subsection quite makes sense. I want to know a little more about the way in which it will work.
I also want to know whether the patient would make the complaint. If not, who would it be? That does not appear to be mentioned. If the doctor were on a practice list, would he be barred from practising or would he receive retraining only? I am not sure about that. How long would he or she have to wait for a verdict?
I confess, I would much prefer that something were done in the Bill to speed up what I consider to be a terrible way of conducting a specific part of the disciplinary procedure, when a surgeon or doctor is accused of a serious offence. No fewer than three such cases have been brought to my knowledge, one by a constituent. He was an anaesthetist who was accused of misconduct during an operation, and he waited for three solid years for the verdict to be reached. All that time, he was paid his full salary and stayed at home, doing absolutely nothing.
I am worried about that. I have mentioned the subject in the House previously, and I regard it as a matter of immense concern, not least because of the money wasted to the health service by that type of thing.
It is also devastating for the accused person, such as the constituent whom I mentioned. Granted, he received his full pay—which he did not want to take because he said, "I am not earning this." However, the matter worried his wife so much that she subsequently became ill and died. In the end, he was found not guilty. How in heaven's name can we deny quick justice and a quick verdict in cases such as that?
I know that it must be a difficult matter for my right hon. Friend the Secretary of State, but because of the waste of money as well as the waste of a man's work and the effect on that man and his family, I should dearly have liked to read in the Bill about a speed-up of the means by which a verdict could be reached in cases of that nature.
The aim of the Bill is excellent. I understand exactly why it came into being. I am sure that it is meant to be, and will be when it has been through Committee, one more improving step for the health service.
Since I have been in the House—in fairly recent years—the patients charter has come into force. In my region, there has been an incredible reduction in waiting lists, which has served my constituents and the people of my area brilliantly. The health service that we see around us has never been so good and has never treated so many people so well, with so many complicated operations, treatments and drugs. We should be thankful for that.
However, I know that my right hon. Friend's constant anxiety is to improve, improve, improve, all the time. That is the intention behind the Bill. I know that my right hon. Friend will not mind that I asked her questions which I feel must be answered if the Bill is to achieve its aim.

Mr. Jim Cousins: It was that wise old Scot, Adam Smith, who said that when two or three were gathered together a conspiracy was waiting to happen. I take a more pessimistic view of the Bill and of the idea of self-regulation than my hon. Friend the Member for Newcastle upon Tyne, East (Mr. Brown). Self-regulation is nothing more than institutionalised conspiracy. That is not a specific point in relation to doctors, but a general point that we have to wrestle with in the Bill and elsewhere. Any system of rules must be capable of clear and robust implementation. The terms used to support the system of rules must be capable of being clearly understood, both by those who use the rules for their benefit and by those who apply the rules.
Rules cannot be adequately measured by the kilo or the cubic metre. The Bill lays down complex procedures. It provides a tangled framework which will create yet more conventions and practices, but it does not give us the clear definitions that the hon. Member for Birmingham, Edgbaston (Dame J. Knight) was rightly trying to establish. What is "serious"? The Bill takes us no further forward: it simply repeats the entirely inadequate terms of the existing structure of rules. It compounds the uncertainty by this time attaching the word "serious", not to misconduct, but to deficient performance. That will confuse the issue still further.
There is no focus behind the system of rules because there is no clarity on the definition of "serious". What is a serious failure of professional performance? The Bill simply does not tell us. It uses the phrase and introduces the concept into our procedures, but it provides no clarity about what it means. In that respect, it is a classic product of self-regulation. Self-regulation will always seek to multiply and mystify. When we add to the idea of serious professional misconduct the concept of a seriously deficient performance, the result is precisely that multiplication and mystification.
The Bill does not offer openness: it offers the promise of openness, which is entirely different. The seven potential stages of inquiry, assessment and counselling before the professional performance committee even meets provide further grounds for multiplication, mystification and uncertainty for everyone involved. That provides the maximum opportunity for old-boy networks—or, indeed, old-girl networks—to come into force.
Lest anyone should think that I am being unduly pessimistic, I shall quote at length—because it is powerful stuff—an article in the British Medical Journal which was written by the chief executive of the Northern and Yorkshire regional health authority. Professor Liam Donaldson, who is a distinguished doctor—

Mr. Malone: Before the hon. Gentleman moves on to the article, I cannot let pass without comment the assertion that phrases such as "serious deficiency" show that there is a conspiracy. Which tests in any legislation governing the law of England, Scotland or Wales are not capable of a number of interpretations? The hon. Gentleman suggests that such standards are unusual, but I suggest that they are not. There is nothing unusual in including such a test, which has to be subject to interpretation, in a Bill of this kind.

Mr. Cousins: The Minister makes a proper and fair point. To guide us as to what constitutes serious


professional misconduct under the existing disciplinary procedures, the General Medical Council's blue book advances several different tests. Some of them, such as not advertising doctors' services, are happily practical. That is the sort of wonderfully practical and specific measure that one always finds in such cases. The 39 articles of the Church of England contain the marvellous phrase, "Cursed be he who moves his neighbour's landmark." Among the greatest mystifications, practical matters can intervene. But the main test in the blue book is as follows:
Neglect or disregard by doctors of their professional responsibilities to patients for their care and treatment".
I invite the Minister to consider how that can be clearly distinguished as a test from any definition which could be given of seriously deficient professional performance. There is a problem.
Let us return to the thoughts of Professor Donaldson. I shall quote from his article extensively because it is so illuminating. One section of the article is called, "Closing Ranks". It states:
Among managers I found general resentment arising from the perception that doctors are so heavily protected and that they seem to be privileged compared with other groups of staff…doctors' colleagues were often willing to report concerns confidentially and informally
but
they were extremely reluctant to go on the record. Some considered that this would amount to disloyalty
and others feared legal action. He continues:
The most difficult and time consuming cases to resolve were those in which a doctor's attitude and behaviour were disruptive or highly unreasonable. So serious did this become in some of the cases I describe that clinical departments were almost brought to a standstill. The resulting poor communication, the absence of teamwork, the atmosphere of hostility, and the poor morale could not, in my view, have been other than detrimental to patient care.
Those are the words of a regional chief executive, who has used the procedures available to him and been entirely unable to resolve those problems.
Professor Donaldson continues:
Judgments about poor attitude and unreasonable behaviour are difficult to convert into evidence which could sustain an action for professional misconduct or incompetence.
He continues in a way that is relevant to the procedures advanced in the Bill. He states:
In several cases the problems remained and were little improved by the process of investigation and counselling.
That is the authoritative voice of a man who has sought to examine many cases in which precisely the issues to be covered by the Bill would have been involved.
Professor Donaldson concludes:
My experience of dealing with problem doctors"—
that is the regional chief executive's phrase, not mine—
over many years leads me to reflect that it is difficult, distasteful, time consuming, and acrimonious work. For these reasons the temptation to avert one's gaze from these problems is at times very great. Add to this the nature of the present NHS disciplinary procedures and I have no doubt that many employers do look away when they should not.
He goes on to throw some doubt on whether the terms of the Bill will be adequate to deal with the problems that he recognises. His summary is that the procedures within the NHS are inadequate to deal with serious professional problems of that kind.
I do not want to take up the time of the House unduly, but in order to throw some light on the matter and to see, not how the rules can be laid down, but how they can be policed, I wish to share with the House one of my own experiences. I tried to discover whether a particular surgical procedure used in relation to an unpleasant sort of cancer affecting women could be carried out without the benefit of histological confirmation by biopsy. The treatment involves radical surgery and its effects are mutilating.
In my attempts to investigate the matter, it took me six months to extract a letter from the Royal College of Obstetricians and Gynaecologists. The letter states:
All clearly state that"—
the particular sort of cancer which I do not want to name—
should be confirmed by biopsy prior to surgical treatment. Whilst the College Council have not discussed this topic, on a personal basis I would not do"—
the procedure—
without histological confirmation of the cancer.
However, such treatment could possibly be given because the royal college has no policing mechanisms in place.
I put the same point to the Royal College of Surgeons. Sir Norman Browse, the president of the Royal College of Surgeons, replied:
The view of this College and of myself personally is that no treatment should be offered a patient—especially any form of mutilating surgery—without full knowledge of the diagnosis. This implies that histological diagnosis should be obtained in all cases, whenever possible, before proceeding to surgery. I do not think there are any surgeons in the UK who would perform"—
the procedure is then named—
without histological confirmation of the diagnosis.
Again, there is no acceptance of responsibility for policing.
I then contacted the General Medical Council to discover whether, within the terms of its disciplinary procedures, it is responsible for policing. It replied that it did not fall
to the GMC to advise doctors on matters of clinical practice in specific situations. This is a function of the Royal Colleges".
But the royal colleges themselves say that they are not prepared to exercise that policing function.
It is a grim and sorry state of affairs when we cannot establish whether such radical, potentially mutilating surgery can be carried out on women only when confirmed by biopsy or achieve a situation in which such a procedure can be established. That must rank—potentially, if it were proved—as a matter of serious concern.
Indeed, the matter raises serious issues of patients' rights in terms of informed consent because the NHS management executive's rules, which I wholly support and endorse, indicate that patients should have such rights. Unfortunately, the responsibility for informing patients of the procedures to be carried out on them lies with the doctors and surgeons themselves. We are going around in circles because there is no procedure in the NHS which can fulfil that requirement.
I understand that a case involving precisely that issue has been laid before the GMC, and there it has remained for many months. I accept that that is not the Minister's responsibility, but it is an important test of the concepts of serious misconduct and serious deficiencies in


professional performance. If we are to discover what "serious" really means, issues such as the one that I have raised should themselves be taken seriously.
I hope that the Bill will advance a new channel for clarifying those issues and I look forward to the proceedings of the Committee.

Mr. Malone: Before the hon. Gentleman finishes, I should make it clear that the GMC has made it public that it will look at the definition of "serious" and will set that matter out in clearer guidance.
The hon. Gentleman is making a bit much of the suggestion that we are engaged in some sort of conspiracy. When three are gathered together, it might be a conspiracy. Is the hon. Gentleman suggesting that the GMC is some sort of conspiracy? When 102 are gathered together and 54 of them are doctors appointed by the royal college and 13 are lay people nominated by the Privy Council, I suggest that that would be quite a conspiracy. I do not think that the hon. Gentleman's theory holds.

Mr. Cousins: I am grateful to the Minister, but I remind him of the news bulletins this morning. Adam Smith was probably rather cynical and pessimistic. Two or three might be thought to be a pessimistic view of a conspiracy, but seven or nine is clearly sufficient.
These are matters which cannot be overlooked. If the Minister is right that the bedrock concept behind the existing procedures and the new ones advanced in the Bill is the concept of "serious", a definition should be available to the House now and should form and guide part of the discussions on the Bill itself. The same request has been made by the hon. Member for Edgbaston and it goes to the heart of the matter.
I do not say that hon. Members are involved in a conspiracy, although presumably in other parts of our lives we can be, but unless the concept of "serious" is clarified for the Bill and for the existing concept of serious professional misconduct, we are no further forward in establishing the clarity, robustness and openness necessary to enable people to be clear about their rights, responsibilities and duties and for those rights, responsibilities and duties to be properly policed and enforced.

Mr. Roger Sims: I listened with interest to the hon. Member for Newcastle upon Tyne, Central (Mr. Cousins) who raised a number of points with which I have some sympathy. Indeed, in the past year, I have had some correspondence and discussions on minimal invasive surgery and the relationship between the General Medical Council and the royal colleges, but I am not sure how far those issues impinge on this relatively narrow Bill. No doubt we will have the opportunity to explore them on another occasion.
Before I go any further, I should declare an interest as a member of the General Medical Council. I thank my right hon. Friend the Secretary of State for her kind remarks earlier in the debate, but I must also declare an interest in the conventional House of Commons sense in that, as is recorded in the Register of Members' Interests, I receive an honorarium from the GMC in recognition of my work as a lay screener, to which I shall refer later.
I suspect that most of our constituents are pretty hazy as to exactly what the GMC is, what it does and what the difference is between the GMC and the British Medical

Association. As recently as last Thursday in the privileges debate, a distinguished and senior hon. Member, while floating the idea of professional self-regulation among Members of Parliament, twice referred to the BMA and its control over doctors.
Of course, the BMA is a trade union of professional people, which doctors are free to join or not as they wish. It is not comparable with the GMC, which was, as we have heard, set up by statute. If I may just correct the figures that my hon. Friend the Minister for Health inadvertently gave a few moments ago, I think that I am correct in saying that, of its 102 members, 54 are elected by their fellow doctors, 35 are appointed by the royal colleges and universities and there are 13 nominated lay members.
As we have heard, there are proposals in the pipeline to increase the lay membership. Those lay members include the hon. and learned Member for Montgomery (Mr. Carlile), who was appointed with me to the GMC in 1989. I know that he would have wished to be here today if other commitments had not precluded that. At that time, no Labour Member was appointed, but we were pleased to be joined last autumn by the hon. Member for Gower (Mr. Wardell) who has already intervened in our debate.
The key to understanding the role of the GMC is that the person who in other organisations might be described as general secretary or chief executive bears the title of registrar, for the very good reason that he is responsible for the register. It is he who keeps it, and no doctor can practise unless his name appears on that register.
The General Medical Council lays down the curriculum for medical training and monitors the work of medical schools. It satisfies itself as to the quality of medical education and it accepts on its register only men and women with the appropriate qualifications. It also has other duties. It recognises—or refuses to recognise—medical training in some places overseas and decides whether doctors trained overseas can practise in Britain with or without conditions. Those are matters outside the Bill, but I can assure my hon. Friend the Member for Birmingham, Edgbaston (Dame J. Knight) that a test known as the PLAB—Professional and Linguistic Assessment Board—test would normally ensure that doctors from overseas have a reasonable command of the English language.
The GMC not only decides the established standards that doctors must reach before practising but is responsible for maintaining those standards. It has to deal with doctors who are brought to the council's attention because it appears that they may have fallen below the standards required.
Cases normally reach the GMC through three routes. First, if a doctor is convicted before the courts, it is virtually automatic that the GMC will be notified, regardless of whether the charge is a fairly simple one of being drunk and disorderly, whether it is shoplifting or a murder. The second route is through the findings of local medical services committees. A doctor who is found not to have kept to the terms of his contract will be reported to the GMC.
It is important to understand the distinction between the relationship between a doctor and his local employing hospital or health authority and the relationship between a doctor and the General Medical Council. A doctor may have been found to have broken the terms of his contract and he will have been dealt with by a local medical


services committee. Ultimately, when the decision has been confirmed by the Secretary of State, that doctor may suffer a withholding of his salary—in effect, a fine—but the circumstances in which he has broken his contract may or may not be relevant to his registration with the General Medical Council.

Dame Jill Knight: I am most grateful to my hon. Friend, because we have a unique opportunity to acquire a great deal of information that is not always easily available to us. My hon. Friend referred to language. He may not be aware that there are quite a lot of complaints about difficulties with language. From what I have just heard, if a patient feels that a doctor has not understood him correctly, that patient cannot complain to the GMC because it has already been decided that the doctor can speak perfectly adequate English.

Mr. Sims: The patient could go to the local family health services authority and say he or she is not happy with the doctor and wishes to change to a doctor with whom he or she would feel more comfortable. That would be the solution in that particular case.
I said that there were three ways in which cases could come to the GMC—through a conviction, through the findings of a local medical services committee and through straightforward complaints from the public, from, patients or their relatives. Virtually all the conviction cases and medical service committee cases and many of the complaints from the public are passed on for consideration to the preliminary proceedings committee—a committee of the council consisting of nine medical members and two lay members, of whom I am one. One of the two lay members must be present for any matters or cases to be considered.
We examine a range of cases, including those that involve sex and, therefore, hit the headlines, but they are a minority. An enormous range of cases comes before us. They include irresponsible prescribing, abuse of drugs, breach of confidence, inappropriate treatment and falsifying the outcome of clinical trials. It is a long list. Each case is considered most carefully by the preliminary proceedings committee. If hon. Members sometimes see me during a late sitting in the Library with a large pile of paperwork, they will know that a PPC is pending. I can assure hon. Members that great consideration is given to each case.
When we consider a case, we can decide that it calls for no action at all. If the matter that has been raised is admitted by the doctor, we can decide that a warning or a cautionary letter in appropriate terms is appropriate, but if there is a prima facie case of serious misconduct, it is passed to the professional conduct committee, a body whose proceedings, though of a civil nature, are very much akin to the criminal courts, with similar standards of proof required.
Anyone appearing before that committee has been charged with serious professional misconduct. There have been several queries as to what exactly that means and attempts to define it. Quite a useful definition is conduct of such a nature as to call into question whether that doctor should be allowed to continue to practise without restriction. The professional conduct committee considers all the evidence and the parties involved appear before it and are examined or cross-examined. The process is

similar to court procedures. The committee can decide to dismiss the case, that the doctor should be admonished or that the doctor should continue to practise subject to certain conditions. It can suspend the doctor for a specified period or it can erase his name from the register altogether so that he may no longer practise.
When the preliminary proceedings committee is examining a case, it may consider that the account it has had of the events that led to that consideration brings into question the doctor's health. The doctor will then be subject to the health procedures to which reference has been made. Under those procedures, the doctor will be invited to undergo examination by other doctors who may suggest a course of treatment or certain restrictions on how he practises, the work he does, and so on. Only if he refuses those conditions or proposals will he then be subject to disciplinary procedures.
Perhaps I could interpolate in my narrative of my work on the GMC a couple of comments. First, contrary to the general perception and the view expressed a few minutes ago, my experience is that almost without exception, doctors tend to be far harder on their own profession than I and my fellow lay members would be. Quite frequently, having examined a case, I have in mind a certain course of action and find that the doctors themselves want to take a stronger line; so it is certainly not a case of doctors protecting themselves.
Secondly, the House is often anxious to protect people against double jeopardy. It is a matter about which we are necessarily concerned. Hon. Members will realise from what I have said that doctors constantly face a double jeopardy situation. A doctor may have been convicted and sentenced by the courts or he may be brought before a medical committee which may then find that he has breached the terms of his contract and his salary is withheld. However, that is not the end of the matter for that doctor. His activities must then be considered by the General Medical Council and his livelihood could be at risk.
The weakness in the procedures which I have described, and of which I have been a part for the past five or six years, lies in the fact that, at the end of the day, the GMC can deal only with single incidents of serious professional misconduct. It is virtually powerless to deal with doctors who appear to be deficient in their knowledge of medicine or in their knowledge of the correct procedures for diagnosing and treating patients. The GMC cannot deal with doctors who show a lack of sensitivity or courtesy to their patients—that does not constitute serious professional misconduct.
The Bill proposes that, when such deficiencies are revealed, there should not be formal disciplinary procedures but that steps should be taken to help to rehabilitate doctors so that, in due course, they may resume full medical practice. To that extent, the procedures proposed are akin to the health procedures which I explained briefly.
The Bill's provisions will offer an opportunity for the doctor to consider and analyse his shortcomings and to discuss and agree with fellow professionals and a lay person a course of action that he could take to remedy those deficiencies. In most cases, he would wish to take such action in his own interests and those of his patients. The question of sanctions would arise only if the doctor concerned refused to take the steps proposed.
I have no doubt that those powers are needed. Cases have come before the preliminary proceedings committee that do not involve serious professional misconduct but suggest that the doctor is below standard. For example, in 1993 the GMC received information from a hospital expressing concern about Dr. N's level of clinical competence. The concerns were such that the hospital decided to dismiss the doctor in question, but, in the event, he tendered his resignation and sought employment elsewhere.
The GMC requested further information about the specific incidents that had caused doubts about the doctor's competence. Although the inquiries revealed a disturbing pattern of clinical deficiencies on the part of the doctor, no specific incident was considered to amount to serious professional misconduct. Similar inquiries were made about an earlier appointment held by the doctor and about the circumstances in which he had left that post. Here, too, there was evidence of a pattern of poor performance as well as evidence that the doctor lacked insight into his deficiencies. Again, however, there was no specific evidence of behaviour by the doctor which amounted to serious professional misconduct, so the GMC was unable to intervene.
In another case, the council received details in March 1993 of a medical service committee report involving Dr. S, who was a general practitioner. He had made a diagnosis over the telephone and he did not visit the patient at home. The patient's condition subsequently deteriorated and he was admitted to hospital where he underwent an operation for an ulcer. The medical services committee considered that the doctor had not placed himself in a position to diagnose the patient's condition properly and to treat him appropriately.
The case was then passed to the GMC because it raised questions as to whether the doctor had been guilty of serious professional misconduct. On the basis of the evidence before it—the GMC bases its decisions only on such evidence—it was decided that it would be sufficient to send the doctor a letter of warning and advice regarding the standard of medical care which patients are entitled to expect.

Mr. Cousins: The hon. Gentleman's example brings us to the heart of the matter: why was it not decided that serious professional misconduct had occurred in that instance? If the case was serious enough to warrant sending a warning letter, why was it not sufficiently serious to be regarded as professional misconduct?

Mr. Sims: I do not have all the details of the case before me, but I have explained that serious professional misconduct involves the question of whether a doctor should continue to practise. In that case it was felt that, although he had fallen short of the standards that could be reasonably expected, the question of suspending him or removing him from the register did not arise.

Mr. Cousins: I do not wish to pursue the hon. Gentleman on this point, and I am grateful to him for giving way a second time. Does he not see that that means that the evaluation of the case was determined not according to the nature of events but by the severity of the sanction? That is precisely the kind of institutionalised self-regulation that is so dangerous in such matters.

Mr. Sims: I do not accept that view. The case was considered carefully in the way that I have suggested and

that was the decision reached in that case. But the narrative continues, because shortly after that incident there was another medical service inquiry about the doctor's surgery hours and his provision of services to patients. In that instance, it was found that he had not complied with his contractual responsibilities but that was not serious professional misconduct.
Shortly after that, the family health services authority wrote to the council expressing general concern about the standards of service provided by the doctor. It referred to the disorganised running of his practice and it mentioned his bad record keeping. The FHSA expressed particular concern about those matters because the doctor had persistently resisted the authority's attempts to improve his performance and to rectify his deficiencies.
The difficulty for the council is that its disciplinary procedures are designed to deal principally with specific allegations that a doctor has behaved towards patients in a manner that may amount to serious professional misconduct. Therefore, it was not able to pursue the case. I accept that, if it had taken a different course in the first instance, things may have been different. However, the doctor's pattern of performance certainly justified intervention by the GMC, but it did not have the power to do so.

Mr. David Congdon: I think that I understand my hon. Friend's point about the new powers in the legislation and how they will enable the council to investigate a doctor's pattern of performance and behaviour. I wonder whether he can help me on another point. When a single act is committed which falls short of serious professional misconduct but which nevertheless deserves some form of sanction, will the new powers in the Bill enable it to be investigated?

Mr. Sims: I understand that they will not because the Bill is specifically intended to deal with cases where there has been a pattern of performance. That is the whole point of the legislation.

Mr. Malone: Let me clarify the matter. If one specific incident showed a deficiency—it would be unlikely to be isolated, as it is more likely to be part of a pattern—it would be possible in certain circumstances for it to come within the procedures that are proposed in the Bill.

Mr. Sims: I am obliged to my hon. Friend.
I shall quote one further case, as it is a graphic example. Two years ago, a surgeon in Yorkshire made errors in his surgical practice that were so extensive that the complaints about him were subject to inquiry by the regional health authority. In its report, that RHA categorised faults, and described a minor fault as being an error which
although falling foul of the Bolam test is readily understandable, in the context of a busy surgical practice, and which is unlikely to be repeated.
It went on to describe an intermediate fault as being an error
of serious proportions, which warrants disciplinary action, or appropriate retraining but which is not sufficient to call into question the fitness of the surgeon to continue in surgical practice, in that appropriate retraining is likely to eliminate the risk of repetition.
It referred to a major fault as being an error
of such substantial proportions as to cast doubt upon the fitness of the surgeon to continue in surgical practice.


In that particular inquiry, the report found intermediate fault in the case of five patients and minor fault in four, but in none of the nine did it find major fault. The case was reported to the GMC, but it was unable to act because, in the light of that classification and the report following a detailed inquiry, there was no single incident of serious professional misconduct. Quite clearly, that surgeon should not have continued to operate. In fact, he retained his position after giving an undertaking to his employers to undergo retraining and to work for a time under supervision. But he could have chosen to leave and go elsewhere—if not practising in the NHS, then privately, without any hindrance whatever. The GMC would have been helpless. He seems to me to be a perfect candidate for the performance review procedures that we are discussing.
Not all the complaints that come to the GMC go before the preliminary proceedings committee. Indeed, if they did, we would be overwhelmed. There is, as we have heard, a screening procedure. A medical screener—one of the doctor members of the council—considers each complaint and whether action should be called for, or whether the complaint should go forward to the preliminary proceedings committee for consideration, or he can decide that it calls for no action. Until a few years ago, a letter in those terms was then sent out.
The president of the GMC, to whom my right hon. Friend the Secretary of State quite rightly paid tribute for the energetic and dedicated manner in which he has led the GMC for a number of years, felt that, if people were to receive a letter telling them that the GMC was taking no action over their complaint, that decision should be not only taken by a medical member but endorsed by a lay member. He asked me, therefore, whether I would accept the office of lay screener, with the task of looking at all the cases on which the council said that it was taking no action. That I did, and I looked at some 40 cases a month. Indeed, after a year or two, the president, realising the burden, appointed a second lay screener. Hon. Members who have noticed the size of their postbags in the past few years may not be surprised to hear that, although there are two of us, I still deal with some 40 cases a month.
Of course, some of the complaints are trivial and, inevitably, some of the letters are from people who—perhaps one could kindly refer to them as such—are eccentric. There are matters that the GMC cannot deal with. People write in to complain that their doctor has knocked them off the list. He is perfectly entitled to do that, just as—as I explained earlier to my hon. Friend the Member for Edgbaston—one can knock oneself off the doctor's list. People write in to complain that the man next door is throwing rubbish over the fence. They say, "He's a doctor. I want you to do something about it." I am afraid that that is outside the GMC's purview, as are arguments between patients and doctors about fees for private medicine.
But some of the cases that I have seen on which the GMC cannot act—I have to agree that it cannot act—leave me uneasy, and they are about doctors who are not up to the standard that patients should reasonably expect. Misdiagnosis is one area. It is easy to misdiagnose symptoms. Doctors are human. They can make mistakes. Medicine is not an exact science. Various symptoms can be interpreted in a number of different ways. Misdiagnosis

is not serious professional misconduct. But if one finds several similar cases of misdiagnosis on the part of the same doctor, perhaps that suggests that he has fallen behind with keeping up to date with medical knowledge, and that the GMC should be able to act. I have to agree to a letter saying, "We are sorry, but the GMC cannot act."
I see complaints about a doctor's attitude. The classic one, sometimes quoted by the president of the GMC, is of the patient who walked into the doctor's surgery, to find him bending over his desk, writing, completely ignoring the patient. As she got nearer, she realised that he was writing out invitations to a drinks party, or whatever. After an interval, without looking up, he said, "Yes." That is not really quite the way in which one expects to be received by a doctor.
I recently saw a complaint from a 20-year-old girl who, with her mother, went to consult her doctor. He sent the mother out of the room, with no explanation, and asked the daughter to undress. He stood watching while she did so. His subsequent treatment of her, the way in which he sought to find out what was the matter, asked questions, touched her in various parts of her anatomy, was generally insensitive. Far from being reassured, that young lady left the surgery in distress. That is clearly not a case of serious professional misconduct. Restricting the way in which that doctor can practise may not be the answer. In fact he may be a rather good doctor, medically, but he needs to be pulled up about his attitude to patients.
We are talking about doctors who have fallen foul of the GMC. Let us be quite clear that most doctors, be they GPs or hospital doctors, are competent, conscientious and caring. But there are some who are simply incompetent. There is a particular problem with locums, who work for a short time, either in general practice or a hospital. Before very long, their shortcomings begin to come to light. By that time, nobody can do anything about it—the locum may be nearing the end of his stay, he may have already moved on or he may been rumbled and resigned. Neither the family health services authority nor the hospital, whichever employed the locum, can take any action because it is no longer that doctor's employer. Often, the hospital or doctor's practice is glad to see the back of that locum and so will do nothing about the problem. However, sometimes the GMC receives an account of the series of incidents that have caused concern about the locum. However, as no one incident could be described as serious professional misconduct, the GMC can do nothing.
I hope that I have clearly shown that in such cases the GMC should be able to act. It needs the powers in the Bill to do the job that Parliament and the nation expect it to do. I hope that the Bill will make rapid passage through both Houses.
Before I resume my seat, I want to refer to the motion on the Order Paper that the Bill be committed to a Special Standing Committee. I have always been an advocate of Special Standing Committees. Indeed, I have sat on one or two of the relatively few such Committees that there have been. I do not think that the procedure is used enough. Hon. Members will be aware that it is a cross between a Standing Committee and a Select Committee. As the hon. Member for Newcastle upon Tyne, East (Mr. Brown) said, it provides an opportunity for people affected by a Bill or with views on it to express those views directly to the Committee, without the need to find


a sympathetic Member of Parliament to do so on their behalf. It is also useful when there has been little opportunity for consultation before a Bill is published.
However, none of that applies in this case. The proposals were first published two years ago and very wide consultation has taken place. At the back of the original proposals are two pages listing all the organisations and individuals that have been consulted. The president of the GMC spent a great deal of time meeting a wide range of organisations and individuals, seeking views that he then took into account in the formulation of the Bill, which has wide support. Therefore, I have to say that whatever the merits of the Special Standing Committee procedure, it is not appropriate or necessary for this Bill. Indeed, it would simply delay our proceedings. I urge support of the Bill, but ask the House to reject the committal motion.

Mrs. Diana Maddock: Few subjects are capable of stirring up such anger and emotion as complaints against doctors. Those whom we tend to regard as saintly while all is going well are too easily cast in the role of devil when treatment begins to go wrong. Of course, most doctors are well trained, careful and competent. To sustain that high standard can be very difficult, which is why we need a comprehensive and thorough system of complaint investigation—to ensure not only that those who fall below acceptable standards can be identified, but that they are brought to account, retrained where appropriate and disciplined where necessary.
The GMC is an historic body, but despite its long history it is often misunderstood. Examples of that have been cited this afternoon. It is not a trade union for doctors, although some of our correspondents seem to think that it is. It does not even deal with breaches of contract by doctors; that is the role of doctors' employers. Its statutory and historic role is to deal with the registration of doctors. That means that it has a duty to register doctors who have reached the requisite level of qualification. It also has the duty to affect a doctor's registration by attaching conditions to it or by the ultimate sanction of erasure from the register if the protection of the public so requires.
During recent years the GMC has changed a great deal. We have already heard that under the leadership of its current president, Sir Robert Kilpatrick, it has modernised itself and is moving towards simplification of some of its registration procedures. It is determined to increase the proportion of lay membership to ensure that the non-medic has a full role in its deliberations. I believe that the measures that we are discussing today would not be before us had it not been for the energetic efforts of many of those lay members, including the hon. Members for Chislehurst (Mr. Sims) and for Gower (Mr. Wardell) and my hon. and learned Friend the Member for Montgomery (Mr. Carlile). My hon. and learned Friend very much regrets that he is unavoidably unable to be present for today's debate. He strongly supports the Bill, as do I and my other colleagues. I believe that increasing lay membership is of great importance for the future credibility of the GMC.
Until now, apart from special procedures to deal with sick doctors, which have already been mentioned, the GMC has been able to affect the registration only of

doctors found guilty of serious professional misconduct, something that we have discussed at length today. Despite the apparent relaxation of the standard of proof permitted by the Privy Council as a result of the McAllister case, the standard of proof remains high and the quality of misconduct amounting to "serious" is unsatisfactorily limited.
Many cases of sheer bad doctoring have slipped through the net. There is a clear need to provide a procedure to deal with the doctor who is sloppy, who is rude, who is persistently inefficient or who is the source of constant complaint from patients, without any particular incident that could be described as serious misconduct. Unfortunately, some doctors are an accident waiting to happen. The procedures introduced by the Bill will enable the GMC to deal with such circumstances. I believe that the intention is not to introduce a new punitive procedure; the emphasis will be on advice and retraining, although the ultimate sanction of erasure will be available for those whose deficiency of performance cannot, in the end, be remedied.
The cost of remedial training has been estimated at £530,000, according to the Bill's financial memorandum. That may be an underestimate, especially if the introduction of the new procedures brings forward a flurry of cases. I hope that the Minister will confirm that should the cost be greater, public interest demands that it should be met in full, save in so far as it is reasonable for the cost to be met by the doctor himself.
The Bill represents a step forward in the consumer's interests and I hope that the House will support it.

Mr. Anthony Coombs: Like a number of hon. Members who have spoken, particularly the hon. Member for Newcastle upon Tyne, Central (Mr. Cousins), I support the principle of the Bill, which can only be good for patients and for the reputation of doctors. At the same time, however, I have some reservations about how exactly it will work out in practice, and about whether the definitions of seriously deficient performance will allow the public's aroused expectation—I am sure that it will be aroused as a result of Bill—to be met in practice.
A danger exists in the Bill. The public will feel that, in relation to a range of performance, if they are not satisfied on a local basis, they will be able to report their doctors to the General Medical Council. When they find that it is not prepared to entertain such complaints, I am concerned that they will be disappointed and that, therefore, we will not have taken any steps forward in improving credibility in or the quality of the medical profession's care for patients.
In the medical service, not just in Britain, but in the rest of the western and industrialised world, the power of the consumer is far greater than it used to be, through both the patients charter and league performance tables, which have been suggested by hon. Members on both sides of the House at various times. The population's deference for doctors has fallen. Previously, doctor always used to be right; now doctor is someone whose judgment can often be questioned. Given that sociological or even emotional change in attitudes to the medical profession in the past few years, it is inevitable that people will demand not only higher standards from doctors, but more specific accountability from them.
The hon. Member for Newcastle upon Tyne, Central quoted Adam Smith in putting forward his ideas about a committee.

Mr. Cousins: I thought that the hon. Gentleman would like that.

Mr. Coombs: Very good. I shall quote an article in The Sunday Telegraph which appeared at the end of last year by Dr. James Le Fanu. He quoted Robert Louis Stevenson talking about some of the virtues that people expected from doctors, apart from professional competence. They included generosity, discretion, tact, heraclean—whatever that is—cheerfulness and courage, which, the article states, brings
air and cheer into the sick room and often enough, though not as often as he wishes, brings healing.
Dr. Le Fanu went on to talk about the seven sins of medicine as described by the late and distinguished Sir Richard Asher. They are obscurity, cruelty—both physical and mental—bad manners, over-specialisation, love of the rare, common stupidity and sloth.
I do not know whether many of those points would come within the definition of seriously deficient performance as set out in the Bill, but I am sure that a significant number of members of the public will expect that they will be able to report any of their doctors who do not exhibit those virtues and who consistently or otherwise exhibit some of the deadly sins to the GMC, and that, as a result of this new consumer-friendly Bill, which we all so avidly welcome today, those doctors should be able to be brought to account. That is dangerous. The public's perception and that of the GMC, which, as our excellent brief from the Library states, anticipates only about 100 to 150 cases per year, may be considerably out of kilter in relation to the credibility problems that I have described.
I have a particular interest in the matter, as, I am sure, every hon. Member does. It so happened that Dr. Carol Starkie, who is quoted as being one of the doctors who could be assisted by the new procedures involving the committee on professional performance, was a constituent of mine—certainly her parents were, and she grew up in my constituency. Hon. Members may recall that, a couple of years ago, she was a consultant based at the Royal Orthopaedic hospital in Selly Oak, Birmingham, and that she was found to have misdiagnosed no less than 42 potentially cancerous tissue samples.
That aroused enormous public concern, including, obviously, among the people directly affected and their families. Five years ago, a family in my constituency—I have not asked whether I may quote them today, although they have been upfront in their complaints—lost a son aged 18 as a result of what they believed to be the professional incompetence of a locum and a local general practitioner. The boy was diagnosed as having a temperature for about four days. It gradually went up from 102 to 104 to 105 deg F. On the Thursday evening, a doctor insisted that he merely had flu symptoms, that the windows should be opened, and that he should be allowed to cool down.
The next day, the boy was admitted to Kidderminster general hospital, where he died the same day. One can understand the devastating effect that that episode has had

on my constituents' lives, and how concerned they are to ensure, not that the people involved should be compensated, but that such incidents should not happen to other people, and that those responsible should be brought to book—not necessarily in the court but through an effective General Medical Council—as being guilty of seriously deficient performance.
As I said, I happen to agree with the principles of the Bill. It would be difficult to do otherwise. Obviously, it is right that the purview of the GMC should be extended from merely considering professional conduct and health to wider terms of professional performance. I can understand the arguments, again very well put in the research paper that we have, that the proposals should apply to every sort of doctor, whether he works in a private practice or hospital, or whether he is a locum.
Nowadays, given the fact that medical practice is changing at an exponential rate as a result of new technology and new techniques, it is all the more important that some grip is kept on professional standards. Like my hon. Friend the Member for Birmingham, Edgbaston (Dame J. Knight), and the hon. Member for Newcastle upon Tyne, Central, who ably set out his case, I have some serious concerns about the definition of seriously deficient performance. I have considered part 2 of the GMC's regulations. It refers to conduct and talks about convictions and forms of professional misconduct that may lead to disciplinary procedures. It mentions
neglect or disregard by doctors of professional responsibilities to patients for their care and treatment
and
responsibility for standards of medical care".
Paragraph 36 states:
The public are entitled to expect that a registered medical practitioner will afford and maintain a good standard"—
not the best standard—
of medical care. This includes: conscientious assessment of the history, symptoms and signs of a patient's condition; sufficiently thorough professional attention, examination and, where necessary, diagnostic investigation; competent and considerate professional management".
All those would appear to be related to medical duties. They are not related to misconduct whereby one is doing unmentionable things to one's female patients. They are directly related to the standard of one's medical duties. If we are saying that the new committee on professional performance can consider only seriously deficient standards of medical performance, we should take account of the fact that such standards are already accounted for in the conditions on conduct laid down by the GMC.
Therefore, if we are genuinely to extend the purview of the GMC to medical competence, we should do so not just for the most serious cases but for cases further down the scale. That was what the hon. Member for Newham, South (Mr. Spearing) wanted to do when he introduced his Bill. As my hon. Friend the Member for Edgbaston said, he has attempted to introduce such a Bill several times in the past six years.
My difficulty is that, although we had the word of the Minister when he intervened in the speech of my hon. Friend the Member for Chislehurst (Mr. Sims), we do not have anything in the Bill. It is significant that the schedule says several times:
The General Council may make rules".


It also says:
The Committee on Professional Performance shall be constituted as provided by the General Council by rules under this paragraph.
I am worried not so much about what we see in the Bill as about what is unseen and what will be decided by the GMC and determined in regulations.
The Library briefing says that the General Medical Council, when proposing a third jurisdiction, emphasised that
there should be an 'equivalence of gravity' between this offence and those of serious professional misconduct and fitness to practice being seriously impaired by ill health.
It said that they should be judged on the same standard. Either the Bill duplicates what is available at present, as I demonstrated a few moments ago, or it does not deal precisely with the type of problems further down the scale that many of our constituents would expect it to deal with, if competence and the GMC's ability to examine it was genuinely being extended.
Nor does the Bill tell us—it is left to the schedule—how cumbersome in practice the proceedings under the Bill will be; how quickly, for example, the concerns of someone who makes a reference to the GMC which goes to the committee on professional performance will be met. Justice delayed is justice denied. My constituents to whom I referred a few moments ago have been trying for eight years to find a reason why their son died and who was, responsible. They still have not been able to do so under the existing procedures. If there is to be a significant improvement and if the system is to be effective, there has to be more speed.
Equally, I hope that access will be easier than it is under the professional conduct proceedings. When I investigated my constituents' case I found that only 9.5 per cent. of complaints ever got anywhere near the professional conduct committee, even though in many cases people had been through the gamut of complaints procedures at local and regional level. I have some worries, which the Minister cannot answer now, about exactly how the Bill will work out in practice. Those matters will be left to representations to the GMC on how it interprets its responsibilities under the schedule.
I believe that the Bill will arouse the expectations of the public as to their ability to make effective complaints against what they see as deficient procedures and standards on the part of their doctors. Indeed, it is happening already. Action for Victims of Medical Accidents, which is the leading voluntary body in examining medical negligence cases, tells me that up to last year it had 14,000 cases on its books. I would suspect that it is very much more now. The patients charter, in emphasising patients' rights rather than patients' responsibilities, is all the time pushing people into a position in which their expectations are rising and, therefore, their potentially litigious feelings are being aroused.
We have performance indicators for different consultants or GPs. GPs are in a more competitive position through fundholding or total purchasing and are providing more and more services to their patients. So I should have thought that expectations would be aroused and that the number of complaints which will potentially go through the system outlined in the Bill will significantly increase—certainly way beyond the 100 or

150 mentioned by the GMC. That raises concerns about how complaints in the health service are dealt with before they ever reach the GMC.
It is likely that a complaint to the GMC will be at the top end of people's aspirations. Complaint to the GMC will be their ultimate deterrent when they find that the performance of their doctor is not what they would like it to be. I know that the Government have examined the existing plethora of complaints avenues. The Wilson committee has written a document called "Being Heard" which referred precisely to the plethora of complaints procedures—what AVMA called a labyrinth of complaints procedures available to the public.
Although complaints procedures may be available, if there is a labyrinth, one cannot get through it quickly. If people think that there is a labyrinth, they do not go into it in the first place. Therefore, some people who would like to make a complaint—probably a legitimate one—about their doctor may be deterred from doing so.
Existing complaints procedures include formal and informal procedures for family health services authorities, hospital administrative review, the hospital clinical complaints procedure and the health services commissioner. Only then does one get through to the civil courts. So there is a variety of complaints procedures. It is no wonder that AVMA has become more and more popular with patients. They need someone to guide them through the labyrinth.
The Government have produced a document called "Acting on Complaints" only within the last month, in response to the Wilson committee document. It proposes that, where possible, the resolution of disputes in the health service should be local, speedy and far more easily accessible and streamlined than the present procedures. If that comes about, it could have one of two effects. Either there will be more satisfied complainants at the lower end who will not go to the GMC or, as I suspect, there will be more complainants and, as a result, potentially more people will complain to the GMC. So if the system outlined in the Bill is to work effectively and not weigh down the GMC in a huge maelstrom of complaints, the Government must get local level complaint resolution procedures absolutely right.
When one talks about quality in the health service and avoiding problems of defensive medicine—matters which AVMA referred to recently—the more one emphasises quality-led outcomes and the more there is the opportunity for subjectivity about what is an acceptable quality-led outcome. Therefore, there is more potential for making a complaint against a particular doctor who does not come up to that quality-led criterion.
It is not merely a question now of saying, "I had my operation. I was in and out and I got better eventually." People consider what treatment they received before going into hospital, how long they had to wait, what their post-hospital treatment was like, whether they went into the appropriate nursing home or whether they had the appropriate home treatment. All those quality-led outcomes, which are rightly demanded by the public, will lead to greater opportunity for people to complain about doctors, whom they believe should manage their treatment in a particular way.
I was somewhat surprised to read in the briefing paper compiled by the Library that the GMC did not see the new powers as in any way directly related to medical audit procedures in the NHS. The powers may not be directly


linked to medical audit procedures in the national health service, but I cannot see how they can be anything but indirectly linked with medical audit. After all, medical audit is about the quality of outcomes and assessing that quality. As I said, if we raise people's expectations of the quality of outcomes and those outcomes are not effectively delivered in every case, people will be more likely to complain about the conduct of their doctors.
In the main I support the Bill, but I am very concerned that the devil, as they say, is in the detail and that what the GMC puts into place, when it looks at the schedules, may not meet the kind of expectations that have been aroused in patients. The problem about arousing—legitimately—expectations of improved service in patients and giving them more rights in the health service is that for every right there is a responsibility. The health service has a responsibility to come up with a particular level of service.
Equally, the public have a responsibility to ensure that they treat their health service appropriately. It is not appropriate—my local doctors have told me of such behaviour—to turn up at the surgery to have a plaster put on, or to ask for a prescription for a medicine which is perfectly easily and cheaply available over the counter, or to ask for advice about nettle rash. Patients should have some cognisance of such activity when they consider their responsibilities to the health service.
Although the Bill rightly makes people aware of their rights and the improved quality of the health service—indeed, they are getting that improved quality from our national health service, which is operating more effectively than ever before—it equally diverts their attention in the long term from their responsibilities in the health service. Only by emphasising people's responsibilities in the health service will we in the long term be able to manage demand for health services which the taxpayer can afford.

Mr. Sam Galbraith: For five years in the late 1980s I was an elected member of the General Medical Council. I was an anti-establishment elected member. The British Medical Association used to run slates. I was not on that slate. I was the only non-slate, anti-establishment, pro-patient representative, as it was termed, from Scotland on that GMC elected body. Therefore I hope that my comments will be regarded in the light of the position that I achieved. I was not there to take part in a conspiracy, as has been suggested, or to be part of some coterie to protect other individuals. I was there to ensure the representation of the rights of patients against the establishment.
When we consider the General Medical Council, it is important to realise—I am not sure that we have quite grasped it yet—that it is not just a disciplinary or sanction body but the final disciplinary and sanction body. Other avenues are open to punish or deal with doctors, some of which the hon. Member for Wyre Forest (Mr. Coombs) read out, including the criminal courts, the civil courts and various disciplinary procedures. What is different about the GMC and therefore why there are many complaints about it, although they are not justified, is that it is the body which removes from a doctor the power to practise.
The GMC removes the power to practise not only in the United Kingdom, whether in the national health service or private health care, but virtually everywhere else in the world. If one graduates from this country and wishes to practise elsewhere, even for a temporary period, one is asked for a certificate from the GMC confirming registration and good conduct. That power is a very important sanction. The GMC is not just some disciplinary body which tells one that one has been a naughty boy and not to do it again; it can finally erase one's name from the register and deny one's fitness to practise.
While I was on the General Medical Council, I did not serve on the professional conduct committee but on the ethical committee, which is totally different and concerned with such things as ethical positions, in vitro fertilisation, disclosure of information, and so on. I did not have much desire to sit in judgment over my peers and some of their naughty antics. It was, however, clear to me that there was a problem in dealing with clinical competence, within which I would also include the attitudes of doctors to patients: rude, offensive, unacceptable attitudes and bad practice over and over again. While a single instance would not often reach the charge of serious professional misconduct, repeated episodes certainly did and we needed a procedure for that.
When I came to the House I therefore co-sponsored the private Member's Bill of my hon. Friend the Member for Newham, South (Mr. Spearing), which sought to deal with such problems with a lesser charge. I have sponsored such proposals for some time and the House will appreciate that I make my comments against that background.
The proposals in the Bill go some way to deal with the problem as I have perceived it over the years. It was a little demeaning of the Secretary of State to try to pretend that the Bill was all a function of and related to the recent changes. We have been seeking a solution to this problem for as long as I have been in medicine, certainly well before the present Government came to power and long before the current changes. Imperfect as it is, the Bill is probably the best answer available so far, but it is one on which we can improve, so a Bill such as that promoted by my hon. Friend the Member for Newham, South is no longer necessary.
This Bill is about good practice, and there are many ways in which we can ensure good practice. It starts off by the selection of medical students. Selection is difficult because it may be based on academic qualifications, interviews and, headmasters' reports. I do not know the exact answer to that problem and many people who will not make good doctors and who will be professionally incompetent will slip through, even with best practice. Good medical education and training is very important, but still people will slip through.
Good advice is also important. Anyone can be a surgeon; with a little competence it is not hard. Just now and again, however, for reasons of personality, attitude or sometimes dexterity, the odd person who so wants to be a surgeon is not up to it. In the past, some such people were allowed to slip through, but that is no longer the case because strong advice must be taken. Doctors have a duty through training to advise people if they think that they are not up to becoming a surgeon, for example, and they are told to change their specialty. Despite all those


attempts to ensure good practice, however, some slip through and some, in fact, were always bad. The Bill deals with those cases and that is why I welcome it.
Nevertheless, I have a number of worries about the Bill, some of which have already been raised. I therefore hope that the General Medical Council—I am sure that it will do this—will monitor the Bill and how it works and that it will report back to the House very soon. I shall now deal with my main concerns about the Bill.
It seems to be assumed that dealing with incompetent doctors is like dealing with sick doctors and therefore the first-rate health procedures in place are very similar. I am not sure that that is all that good a parallel. There are trivial differences to begin with. Most sick doctors at least were well at one time and became sick, whereas some doctors have always been incompetent. Although that may be a trivial difference, it has practical implications and therefore the method of dealing with a sick doctor is not necessarily the same.
Perhaps different grades of doctors should be taken into account. I would be happy if the Minister would explain in Committee who is referred to the various committees. Who is referred to the health committee? Is it drunken, alcoholic consultants or junior doctors? Will junior doctors be referred for incompetence or will it be consultants? Again, that will reflect on public confidence in what is happening and how we can manage the problem.
Another way in which the problem is different from dealing with sick doctors is that patients, health authorities and employers of various sorts are more sympathetic to sick doctors. If a doctor is shown to be sick and has to be sorted out, he or she is given time, help and consideration. But if doctors are just no good and incompetent, should the employer be understanding, retain them as employees and have them in the hospital? The decision will have serious implications for the doctor's contract, how they are dealt with and whether they are retrained. Again, the case is not quite the same as that of a sick doctor.
The hon. Member for Birmingham, Edgbaston (Dame J. Knight) mentioned referral, which also worries me. Contrary to what was said by the hon. Member for Chislehurst (Mr. Sims), who is also a member of the General Medical Council, anyone can refer a case; but again, there is a difference between sickness and incompetence.
If one's problem is alcoholism one might be referred to the GMC via a route that does not affect one's contractual obligations and the employing authority could not question that. For example, one might have been done for drunk driving for a second time—one drunk driving offence results in automatic referral—but one can be treated as a sick doctor without it involving one's contract with the employing authority. If one is an incompetent doctor, however, I see no secondary position. The case must be referred in relation to one's practice and it will be more likely that the contract will be terminated. A hospital has no obligation to retain an incompetent doctor.
There are important differences in the way in which we deal with sick doctors and incompetent doctors, for example, in relation to retraining and who pays for it and their future in the service. If a patient refers a doctor because of incompetence, the case goes to the GMC, but not to the employing authority. If the doctor is found to be incompetent, but is still employed, who will pay for

retraining? If the hospital has found a doctor incompetent and sacks him, he is in a different position from a doctor whom a patient has alleged to be incompetent.
What do we mean by incompetence? I hope that the Minister of State will deal with that. One might be an incompetent orthopaedic surgeon, but not an incompetent doctor. One might make a good doctor in some other specialty. Will one be paid to retrain? What of the consultant orthopaedic surgeon who is found to be incompetent? Will he be retrained as a neurosurgeon, a physician or a radiologist? And who will pay? If one is incompetent in one specialty, must one's name be struck off? Or will one be registered for all practice except, for example, neurosurgery? That is an interesting development and it will be interesting for the GMC to consider whether there will have to be different types of registration, with registration of competence but only within certain specialties.
Those are some of my worries about the idea that dealing with incompetent doctors is similar to dealing with those suffering from ill health.
It is right that the method should not be directly related to audit, which the hon. Member for Wyre Forest mentioned. There can be an indirect link, but audit is a slightly different practice. In an audit, a doctor considers areas of practice in which it is not known how he or she is performing and if it is found that there are discrepancies, the matters are dealt with. One might not be good at one procedure, but be better at others. It might be a case of the numbers of such procedures with which one has dealt. If one is not good at something, it will be necessary to change one's practice.
A case might come before the GMC if one was shown to be poor at a procedure but continued to practise in the same way. That would be grounds for referral and it is indirectly related to audit. I hope that the hon. Member for Wyre Forest sees the distinction. It is not that I do not think that audit is important. Its purpose is to detect poor performance, but the action that is taken following that procedure is what matters. If a doctor is bad at one procedure, that does not make him or her incompetent.
The area that worries me, which is in the blue book and is what professional competence is all about, is not competence in a specialty or one area of it, but how one relates to, treats and manages patients. Rude, offensive and bad behaviour must be a basis for referral to the GMC and for being considered under the procedures in the Bill. Such behaviour is bad enough to be considered professional misconduct. In other words, doctors must treat patients with respect and some sort of dignity. Patients must be able to have confidence. They must be able to expect proper clinical history taking, examination, the appropriate diagnostic tests and, if necessary, treatment. Taken as a whole, that is the area with which the Bill probably deals best, and that is why it is not appropriate to deal with it under the heading of serious professional misconduct.
I do not think that there is a conspiracy to protect doctors. That is why I am not worried about the initial stages taking place in private. Anyone who has served on any disciplinary body, as the hon. Member for Chislehurst and I have, will know that there is no attempt to cover up or to protect. Doctors are concerned, first and foremost, to protect patients; secondly, to protect the profession; and, thirdly, to protect the hospital in which they work.


Although I have those reservations, which I hope that we shall be able to explore in Committee, I believe that the Bill is an important step forward. It in part solves a problem that we have been trying to solve for many years and I very much welcome it.

Mr. David Congdon: First, I thank the hon. Member for Strathkelvin and Bearsden (Mr. Galbraith) for his thoughtful speech. I have listened carefully to the debate. Before I came into the Chamber, I had no reservations about the Bill, but various contributions have highlighted some of my concerns.
To put some of the issues in context, we heard from the hon. Member for Newcastle upon Tyne, East (Mr. Brown), the Opposition spokesman, and from my hon. Friend the Member for Chislehurst (Mr. Sims) about the vast range of cases that are referred to the General Medical Council and how few result in a decision of serious misconduct for a variety of understandable reasons.
The hon. Member for Newcastle upon Tyne, East also mentioned consistency between the procedures for dealing with doctors and those for other health professionals. I have some sympathy with that approach. The Standing' Committee should bear it in mind.
We must also consider the Bill in relation to other complaints against doctors and the recent White Paper on the subject. I echo the concerns of my hon. Friend the Member for Birmingham, Edgbaston (Dame J. Knight), who reminded us of the number of complaints against doctors, which are leading to a rise in professional medical insurance. There is a danger that that will lead to doctors not only prescribing defensively, but practising medicine defensively, which is not always in the best interests of the patient.
I pay tribute to my hon. Friend the Member for Chislehurst (Mr. Sims) for his work on the General Medical Council. It is too easy to assume that, when a colleague is appointed to such a body, it involves just the odd meeting. He referred to occasions when he has been in the Library with volumes of reports. I have seen him burdened with those volumes of reports and appreciate his difficult role. He deserves our respect and support.
Whatever we might say about doctors who perform badly or do not deliver the right quality of medical service to their patients, they are in the minority. The majority of doctors do an excellent professional job and I hope that anything that I say subsequently will be put in that context. In discussing complaints, we are in danger of creating the impression that all doctors perform badly, which is not the case.
However, there is a problem with the GMC's current powers. My hon. Friend the Member for Chislehurst said that the cases highlighted in the press usually involve sexual matters and the public have the impression that those are the only cases that are investigated. That does a great disservice to the medical profession because such cases are only a small percentage of those that are investigated. I hope that the new powers will go some way towards changing that perception.
As the powers currently available to the GMC enable it to deal only with serious professional misconduct, the Bill limits the sort of cases that it can investigate. Earlier this afternoon, we had an interesting exchange of views about exactly what are the powers in the Bill. I confess that that aspect worried me as I listened to the debate and I decided to take a further look at the Bill. Frankly, it does not tell me a great deal. I realise that a lot of work has gone on behind the scenes to bring forward these proposals and I do not dispute the work that the GMC and others have done, but I am not sure exactly what the Bill, to which the House is being asked to give a Second Reading, really means. That does not stop me supporting it in principle because there are clearly gaps in the current legislation, but I hope that the Committee will examine the Bill in detail and try to deal with some of the concerns that have been raised today.
As my hon. Friend the Member for Chislehurst explained excellently, the gap in the current provision means that, although the GMC may be concerned about a doctor's performance, that performance falls short of serious professional misconduct. At the same time, it may be aware of a pattern of similar occasions on which the doctor has been deficient. As matters stand, the GMC does not have the power to deal with such a case because it can deal only with a single act. I understand that the Bill is designed to deal with that problem.
The interesting exchange this afternoon was about whether the Bill, in addition to giving the GMC the power to deal with serious deficiency based on a pattern of behaviour, provides the power to deal with a single act. The Bill is not clear in that respect.
I was struck by the Library research paper, which said that the hon. Member for Newham, South (Mr. Spearing) had introduced a private Member's Bill in six different Sessions of Parliament to try to deal with that specific issue. He said that a child in his constituency died of meningitis after his GP had said that he could not be bothered to examine him. I have difficulty with such a case because, while the doctor had clearly not performed to the standard that we would expect of him, the question is: how adequately would the Bill deal with such a case? Could the GMC take action only if there were other examples of similar behaviour by that doctor?
I hope that the Committee deals with that issue because in many cases in the health service doctors might not perform at the level that we would expect of them. Some cases will be comparatively trivial but others will be serious and fall within the GMC's current powers. There will be other examples where action should be taken and I urge that the matter be considered carefully, because it might be a single act that falls short of serious professional misconduct, as evidenced by the hon. Member for Newham, South in a previous debate.
No one is in the business of trying to hound doctors and make them behave more defensively than they are sometimes forced to behave now. Rather, it is a question of having procedures in place to deal with a variety of under-performance, whether it is a serious act under the current powers or a less serious act, so that those matters can be dealt with.
It is not entirely clear, particularly as a result of proposals that the Government recently brought forward, what the relationship will be in terms of powers of complaint to family health services authorities and, conversely, powers of complaint to the GMC. I appreciate


that the FHSA case is more akin to the employer-employee relationship because it is not direct, whereas the GMC is much more concerned with the professional aspect and has the ability to deregister. I agree with my hon. Friend the Member for Chislehurst that that is crucial, particularly in relation to local doctors. It is no good someone saying that a doctor is not up to standard if that doctor is merrily practising as a locum all over the place and employers are pleased to get shot of him or her. It is important to deal with that issue, too.
Despite what I have said, I support the principles of the Bill because it fills a gap in current legislation. My only concern is whether it goes far enough. If the Minister cannot expand on his earlier intervention when he said that the Bill could deal also with single acts where a doctor fell short of professional performance, I hope that that matter will be dealt with properly in Committee.

Dr. Tony Wright: Although all hon. Members who have spoken so far support the Bill in principle, it is interesting that a critique has developed during the course of the debate about some of the problems and deficiencies in the Bill. The Bill deals with "serious deficiency of performance" yet the issue that we are all trying to address, and think that the Bill should address, is what we might call "consistent incompetence". Although we may think that the Bill is designed to deal with consistent incompetence, if it is concerned only with serious deficiency of performance, as defined in normal GMC criteria, we shall ultimately find that it has not solved the problem which we thought we had set out to solve in the first place. That is the heart of the problem with the measure before us.
As Members of Parliament, we must proceed a little gingerly in the realm of self-regulatory activity as we can hardly offer other professions a shining example of how they should conduct themselves. A little humility might even be in order. Although I agree with other hon. Members that the majority of medical practitioners are exemplary in their skill and their commitment, we know that we have a problem that must be addressed. If we do not get it right this time, we will make things worse, not better, because we will have pretended to solve the problem.
One of our initial difficulties is even deciding the scale of the problem involved. The Secretary of State used the same words as the president of the GMC when she spoke about a small number of consistently poorly performing doctors. What on earth is "a small number"? We do not know because it has never been investigated, but it is a crucial question.
On 4 December 1994, the health correspondent of The Observer wrote an article with the headline:
Medical Mafia covers up Errors".
He reported that a study of poorly performing doctors was about to be published by the Open University Press in a book entitled, "The Incompetent Doctor". That study revealed that of the 95,000 doctors in practice in the United Kingdom, up to 10 per cent. were estimated by some of those interviewed to be a potential danger to their patients. One professor of surgery said:
In Britain we tend to turn our backs on these things. It is not easy to recall where people were willing to confront incompetence.

The study also quoted the manager of a family health services authority who estimated that 10 per cent. of local GPs were "impaired". He confided:
It is almost impossible to force a resignation. It just has to be horrendous for anything to happen.

Mr. Malone: Before we embark on a route of what I might describe as overestimation, it might be sensible to point out that the GMC has had a certain amount of correspondence about the people likely to be subject to the new rules. Based on its knowledge of the matter, it has estimated that perhaps some 150 or so cases might come before it each year, of which 50 may proceed to further stages. The hon. Gentleman should put that estimate in the context of what we expect from the Bill, which is clearly distinct from the exciting pieces of literature to which he is referring, and which offer estimates of a considerably greater number.

Dr. Wright: I am bound to say that I was about to make the same point to reach a different conclusion.
One of the consistent problems highlighted in the responses to the consultation exercise from some of the interested organisations was that they did not know the numbers involved. The Open university study—the figures may be too large—reveals that we have a serious problem that may affect one in 10 doctors. If that is so, we are talking about nearly 10,000 doctors. That is a rather alarming prospect. Let us hope that it is not true, but there is a huge mismatch—the point of the Minister's intervention—between the scale of that problem and the figure of between 100 and 150 cases that the GMC says might come before it as a result of the new procedures.
We should take some care to investigate as far as we can the scale of the problem. We know, however, that we have a problem that has not been addressed. Everyone who knows about it has sought for a long time for something to be done, but response has been consistent inaction. The BMA, in a masterly understatement, has said that the Bill is a long overdue measure. It is, because the problem of poorly performing doctors has been with us for a long time. We all know that the system has not managed to deal with it.
I endorse many of the plaudits bestowed on the GMC, but we should ask why, over the years, the GMC machinery has not managed to bring within its definition of serious professional misconduct all those things that normal people would consider to be serious professional incompetence. That indictment of the system should be put alongside any plaudits and congratulations that might be offered to the GMC today.
The way in which people try to raise queries about the performance of doctors or try to complain as patients or the relatives of patients is a profoundly unsatisfactory business. One of the matters about which I feel consistently most dissatisfied is how constituents who try to raise questions and make complaints about the service they have received from the health service are treated. I am sure that other hon. Members share that feeling. Those constituents are left totally dissatisfied by the outcome of any inquiries made. That is part of the problem that we must address now.
I should like to give four examples of the type of behaviour that I am talking about. Two of them came to my attention simply from my work on the Parliamentary Commissioner for Administration Select Committee, which deals with the health service ombudsman. That


Committee has heard evidence from a succession of health service personnel, including doctors, who have come before it because they have been judged deficient in some way by the health service commissioner.
One case from 1992, which was referred to the Committee, involved a consultant at the Royal Free hospital at Hampstead, who behaved quite improperly in a case of child abuse. In fact, it was not a case of child abuse, but he told the mother that he thought that it was. His behaviour was contrary to the guidelines that the Government had just issued in the wake of the Butler-Sloss inquiry following the Cleveland affair. It was a most alarming case and the Select Committee stated:
We consider it extraordinary that a consultant charged with revising the procedures in connection with child abuse should disagree with management on the nature of those guidelines.
The consultant told the Committee that he did not feel that the guidelines issued by the Department applied to him because, as a consultant, he knew better. We should ask what happened to that consultant. The answer is that he is still consulting away. I am sure that the GMC has not actively intervened in the matter.
The second case before the Committee was even more appalling and involved a consultant at the Manor hospital in Walsall, which deals with many of my constituents. Not only did the consultant fail to tell the relatives of a patient that he was suffering from cancer, but he just happened never to get round to telling that patient the diagnosis. Such behaviour is unbelievable. When the patient's family subsequently complained, the consultant said that he never answered letters from patients and certainly never answered those from solicitors. The Select Committee of the House stated:
It was the consultant's responsibility to ensure that effective communication of suspected diagnosis took place; something he signally failed to do on this occasion, not, it appears, for the first time.
In other words, that consultant's behaviour followed a consistent pattern, confirmed by the chief executive of the trust. The Committee also said of that case:
We see the need for a culture change in the minds of many of the consultants who appear before us.
Whatever the GMC and the new proposed procedures may do, they will not bring about a culture change on the part of such consultants.
Another case involves my constituent, Mrs. Ashley, who died leaving her husband in despair at his inability to get her condition taken seriously. His wife suffered from ever-worsening back pain and he had taken her on a number of occasions to the accident and emergency departments, which could not help. When we finally obtained an independent clinical review, the general practitioners did not even deign to give evidence. The consultant to whom my constituent wrote in despair at his wife's condition did not even bother to answer his letter. The independent clinical review said that that was indefensible. Has such a case been near the GMC? Of course not.
My final example is a case involving one of the consultants that I have already mentioned, at the Manor hospital in Walsall. He treated a case as constipation when it turned out to be cancer. One might say that that was simply a misdiagnosis, but the independent clinical review concluded that it was not; it was poor clinical

performance, because the man never carried out the obvious tests that would have established what the condition was. So there was never any proper terminal care for the person involved—who therefore lived and died in agony—or any proper care for the family.
Indeed, the independent clinical review said that there should be a surgical audit of all the procedures carried out by that consultant at that hospital. Yet, has that case been near the GMC? Of course it has not. I had a letter from the chief executive of the trust, who told me that Mr. So-and-So, the consultant—I shall not give the man's name—"acted properly". That was written before the independent clinical review.
Rightly, the family has written to tell me that the consultant is still practising on my constituents, and to ask what is to be done about him. The answer is that nothing has been done, and the chances are that nothing will be done. Whatever the numbers may be, whether small or large, that man should certainly be counted as one of them, and on behalf of my constituents I want something done about that. I hope that we all do.
We all hope that the Bill will produce improvements but I, like other hon. Members, have some worries. I am worried about the definition of what is serious and what is not serious, and about the inconsistency of definition in that area as opposed to other professional areas, such as that governed by the United Kingdom Central Council for Nursing, Midwifery and Health Visiting. I think that the general rubric of professional misconduct could well be extended to include the kind of routine incompetence that has been discussed today.
I am also worried about the resolute way in which the GMC tells us that it will get into the business of being proactive. It will do nothing to initiate any investigation into whether people are performing properly, but will wait for cases to come to it. No doubt that explains why it says that it expects to deal with so few cases.
In many ways that is the key issue—the general lack of effective clinical monitoring within the system. Somehow we seem to expect the Bill to solve that larger problem, but I do not think that it will. Indeed, I feel rather sorry for the GMC in that respect, because if the GMC cannot play that role, who will? Which part of the system will carry out consistent clinical monitoring?
Another example of a particular worry concerns the clinical performance of many single-handed general practitioners—a worry endorsed by much of the research that has been carried out. Having recently discovered that in my part of the world there are many single-handed practitioners who carry large lists and seem to refer people to hospital at a high rate, I asked my family health services authority what it intended to do about the indicators that suggested that we had a problem with the quality of primary care. The answer was that it could do nothing.
All that the FHSA was doing was to examine prescribing patterns, because that is an initiative designed, quite properly, to cut costs and to achieve uniformity in prescribing. But it does not address the issues of quality and of clinical performance. It should do so, and I worry about that.
The Secretary of State said earlier that doctors had a duty under the internal guidance in the blue books to let it be known if they thought that any colleague was


professionally incompetent. Yet clearly that is not happening. If it were, the figures and the evidence that we have discussed would not be there.
I should like there to be a requirement in the Bill to ensure that, as a matter of professional conduct, if a medical practitioner comes across professional misconduct and consistently poor performance he or she has a duty as a doctor to inform the professional body concerned.
Although there is a broad consensus that something needs to be done, worries have been expressed, not only in the House but by the Patients Association, by the Association of Community Health Councils for England and Wales and by consumer groups, about whether the Bill has got it right yet or whether there are areas that still need to be tightened.
I was alarmed to see in yesterday's edition of The Independent an article about the Bill that said:
The Bill has been introduced only on condition that the Opposition will facilitate its passage and not try to alter it".
I am all in favour of facilitating its passage, but—

Mr. Nicholas Brown: Before that idea gets going I shall kill it stone dead here and now. Nobody has said anything about not trying to alter the Bill; we merely said that we would facilitate its passage. Of course we can still try to amend the Bill, but we shall do so crisply.

Dr. Wright: I expected my hon. Friend to respond if I gave him a cue, and he did so admirably. Obviously it is the duty of the House to consider measures that come before it critically—and, I hope with a measure such as this, in a bipartisan way. I know that the Opposition will help in that process.
Finally, as several hon. Members have said before, the Bill must be seen in the context of a whole range of measures designed to improve matters in general. The new national health service complaints system, the attempts by the royal colleges to think about recertification and re-accreditation, and the clinical performance initiative are all most important.
I do not want to get distracted, but if only the Government had not been so crazed in their determination to make organisational changes in the health service and to set up a quasi-market for their own ideological reasons, but had simply devoted themselves to the quality agenda all those years, we could have made serious progress on the fronts that impact directly upon the quality of care that patients receive.
We are talking about the oversight of a profession, and one of the arguments that has emerged from the debate, concerning the inconsistency between how things are done in this area and in other areas, might even suggest that the time has come for one body to have oversight of all the professions, so as to ensure consistency. Having listened to the debate I am more persuaded of that case than I was before.
We have come to the end of a road. In another context concerning self-regulation, we were once told that it was last-chance saloon time. Perhaps it is now last-chance surgery time. We must get the balance between professional interests and the public interest right now. I am not yet persuaded that the Bill does that, and we must ensure that it does.
Finally, I shall mention the procedural point. In a motion on the Order Paper some of us have suggested that it would be entirely appropriate for the Bill to go to a

Special Standing Committee. The more I have heard of the critique that has developed during the day, the more I have felt that to be right.
It is essential that we spend some time exploring the rationale for the Bill in a bipartisan way, teasing out some of the issues, before we start the usual, line by line, ministerial defence of the Bill that is the disabling feature of so much legislation that is created in this place.
Few measures have passed through the Special Standing Committee procedure since it started in 1980—the Mental Health (Amendment) Bill in the 1981–82 Session, the Matrimonial and Family Proceedings Bill in the 1983–84 Session and now the Children (Scotland) Bill. Those are similar measures to the one before us, in that they needed thorough, bipartisan scrutiny.
I shall conclude by quoting what the distinguished then Leader of the House, Norman St. John Stevas, said when introducing that raft of procedural changes, including the Special Standing Committee arrangements. Speaking about Special Standing Committees, he said that
Government Bills which raise substantial issues, not of acute party controversy".—[Official Report, 30 October 1980; Vol. 991, c. 725.]
should be subject to that type of arrangement.
The case for that has been made in today's debate. We need a few sessions in which Members who are interested in all that can explore further the aspects that we have begun to discuss today, before we start the usual progress of the Bill. It will be appropriate and helpful if, when the Minister replies, he brings us good news on that front.

Mr. Nigel Evans: I am grateful for the opportunity to make a contribution to the debate.
I believe that all of us, as Members of Parliament, are interested in the health service, especially the national health service. We wish to ensure that the high standards that have been reached in the national health service are maintained and improved. The Bill will help to do exactly that.
Many sectors make up the health care industry, in both the private sector and the national health service. I use the national health service; I am a customer of the national health service, and I find it to be excellent.
There are many good news stories in the national health service, which do not receive the coverage that they deserve. My hon. Friend the Member for Croydon—

Mr. Congdon: North-East.

Mr. Evans: As my hon. Friend the Member for Croydon, North-East (Mr. Congdon) said, although some cases cause anxiety and improvements need to be made, that does not detract from the fact that the vast majority of people who work in the national health service at all levels do so to the highest possible standards. However, that fact does not prevent us from drawing attention to cases where they fall below those standards.
The bad news stories always catch the headlines. I have appeared on "Kilroy" a couple of times when the national health service has been mentioned, and the programme makers appear to be able to pack an audience full of people who have gripes about the national health service, when we know that the vast majority who use the national health service regard it highly.

Dr. Robert Spink: Is my hon. Friend aware that in my local hospital, the Southend Health Care


NHS trust, the director has done a survey of the letters of thanks that he has received versus the letters of complaint, and that the letters of thanks, which generally go straight to the ward, are pinned on the notice board and are seen by the nurses and staff, far outnumber the letters of complaint that come in from time to time?

Mr. Evans: I am extremely grateful to my hon. Friend for making that argument. The vast majority of people—in excess of 90 per cent. of those who take part in polls and have used the national health service—speak highly of it. Yet a small number of those who use it and who find that the service falls below the standards that they expect, make the newspapers. My hon. Friend has just spoken about the letters of thanks. Would it not be wonderful if we could read some of those good news stories in our newspapers from time to time?

Mr. Cousins: I am puzzled about what happens to the letters of complaint. We have heard about what happens to the letters of thanks. What happens to the letters of complaint? Can the hon. Gentleman throw any light on that?

Mr. Evans: Those letters of complaint are investigated, in the main, but unfortunately most of them receive all the publicity, whereas letters that compliment the dedication of those who work in the national health, service do not receive the airing that they deserve. Unfortunately, that is the case in many sectors, not only in the national health service.
I have anxieties about one aspect of the national health service—ageism. A constituent, Arthur Hornby of Janice drive in Fulwood, has a specific problem. For two years, we have been fighting that case in connection with the bad treatment that he received at Hull royal infirmary. We have not received satisfaction on that issue. My constituent's GP referred him to Hull royal infirmary. It was felt that he should have gone to a cardiac ward there, but he was placed on a general ward. Only after a further heart attack was he referred to the ward where he should have gone in the first place.
We suspect that there has been a blatant case of ageism in that case. We have taken that complaint to several levels. We are still not receiving satisfaction and we shall continue to pursue that case until we can ensure that any examples of ageism are stamped out of the national health service.

Mr. Cousins: May I assume that that problem, which concerns the hon. Gentleman, has been handled modestly and without undue publicity?

Mr. Evans: Arthur Hornby has himself ensured that that case is receiving the right publicity. In some cases it is the publicity—

Mr. Deputy Speaker (Mr. Geoffrey Lofthouse): Order. That is all very interesting, but the hon. Gentleman is straying from the subject of the debate. Will he get back to the debate, which is on the Medical (Professional Performance) Bill?

Mr. Evans: Thank you, Mr. Deputy Speaker. Mr. Arthur Hornby would wish me to mention the performance in that specific case. I know that it may fall outside the parameters of the specifics of this particular—

Mr. Deputy Speaker: Order. Whoever wants the hon. Gentleman to raise that matter, if it is outside the debate, he cannot raise it.

Mr. Evans: Thank you, Mr. Deputy Speaker.
There are other examples of good news about the national health service that do not make the newspapers. On Friday, I spent all day visiting district nurses in the Clitheroe practice. I also visited Lancashire Ambulance trust and saw some superb news going on there. In the evening, at an award ceremony in my constituency, I met more district nurses operating in my constituency.
I have also visited GPs in the Clitheroe practice and discussed the concerns that GPs have in Longbridge and Whalley. One cannot discount the fact that far more pressure is placed on GPs these days than was the case in the past. The expectations of patients are exerting more pressure on the GPs. GPs are now given more freedom to take more power to help their patients, to prevent them from going into or being referred to hospital. I believe that, in some cases, that pressure and the expectations of their patients lead some of the patients to believe that they are not receiving the due care and attention that they would wish to have. They wish to ensure that the highest standards are met, especially by GPs.
Millions of patients are treated by GPs every year. The vast majority of people who are treated by the 26,000 GPs receive excellent treatment. Not all of that practice will be consistently high, and I believe that that, in some cases, is where the Bill will come in and ensure that standards are raised. The Bill aims to meet that challenge.
That does not mean that, in every case when patients write letters, they have good cause to write. It is simply that the expectations are much greater. People are now given more information about how to complain about the service that they receive. People know how to complain and are doing so, which is good. Patients and customers of the national health service will also want to know that their concerns are being dealt with properly, and the Bill will help to ensure that.
Like other hon. Members who have spoken, I am not saying that the Bill is absolutely right in all its aspects. That is where the Standing Committee will play a role. As the hon. Member for Newcastle upon Tyne, East (Mr. Brown) said, amendments will be tabled, perhaps from both sides of the Committee, to ensure that the finished Bill will be far better than the original one. We shall see what happens in the Standing Committee. It is important to note that the system that is adopted may prevent the need for investigations and complaints in the first place. That would raise the standards of the general practitioners and of those who work in the national health service.
I am sure that we have all received letters from the BMA, which has welcomed the Bill. It has reservations, but in the main it welcomes the Bill. The measure will ensure that the professional standards of all those who work in the national health service are maintained and, in doing so, it will benefit the profession.
The BMA raises some points that need to be considered, including the subject of retraining. The assessment of doctors' knowledge, skills and attitudes in the practice and their retraining will ensure that they are kept up to the required standards. The profession is constantly changing. The BMA wants to know who will pick up the costs of retraining, which is a fair question. Now, nearly £40 billion is spent on the NHS and £800


million a year is spent on training. Will the cost of retraining those GPs and others who work in the NHS come out of that £800 million, or will additional resources be made available for retraining? That is one question that must be answered.
How many people who work in the NHS are expected to need retraining? That is something that we need to consider. The profession is constantly changing; new technology is being introduced all the time, and new procedures such as keyhole surgery mean that patients stay in hospital for shorter periods. What will be the retraining costs for such procedures? Will they come within the confines of the Bill? We need to know the facts.
Many people examining our proceedings today will be surprised that we have waited so long for the Bill. Many people will have expected a procedure to have been set up to replace the current everything-or-nothing system. It is clear that the current procedures would not be sufficient to meet the sort of complaints that many of us receive as Members of Parliament. I hope that the Bill will introduce procedures in which people have confidence, so that when they complain about deficiencies, their complaints will be dealt with. Complaints should not fall foul of a system where they are not serious enough to warrant the General Medical Council taking action to correct the problems. The Bill will be extremely welcome if it achieves that aim.
Other hon. Members have mentioned the audit and suggested that the Bill should not involve audit. I agree, but the audit within the medical profession has a role to' play in ensuring that all those who work within the NHS and reach a high standard give a lead to others, so that they raise their standards and we ensure that money spent in the NHS is well spent. Such procedures will include referrals to hospital and the amount of prescriptions currently written by some GPs.
The Bill's effect may be to raise the number of complaints referred to the General Medical Council. An increase in the number of complaints does not mean that standards are lowered—quite the opposite. It means that scrutiny is being improved, which has to be welcomed. The measure must be seen in the context of the pressures currently exerted on the NHS, the demands and expectations that we have of it and the vast amount of good work that is being carried out within it. One has only to talk to people from abroad to discover that they look at what goes on in this country and admire it.
We have the best health service in the world. We have the world's favourite health service and we wish to see it maintained for the future. That is why I welcome the Bill.

Mr. Piers Merchant: It gives me great pleasure to follow my hon. Friend the Member for Ribble Valley (Mr. Evans). I particularly endorse his last few remarks and associate myself most strongly with them. I listened with great interest to the earlier part of his speech. He was right to say that, these days, the spotlight of public attention is very much on health matters generally. Although the Bill deals with one specific and fairly narrow part of that subject—the conduct of doctors in the medical profession—that must be understood to be a matter of concern within a much broader picture. My hon. Friend was right to draw attention to that.
I listened to my right hon. Friend the Secretary of State when she opened the debate. She was right to mention the public's greater expectations. I should like to apologise to

the House for missing a short part of the debate after that, but I was sitting on a Standing Committee, where I was required. I was sorry to miss the contribution of the hon. Member for Newcastle upon Tyne, East (Mr. Brown), not just because he is the Opposition spokesman on the subject but because I have listened to him on many occasions with great interest. I know him to have a well-measured approach to all matters debated in the House.
I also regret missing the contribution of my hon. Friend the Member for Chislehurst (Mr. Sims), particularly as he has given long service to the General Medical Council, of which he is a lay member. I also regret missing his contribution, because of his interest in, and knowledge of, health matters, which is considerably greater than mine.
I have for some time been critical of the existing complaints procedure and the disciplinary system within the medical profession. When I was first elected as Member of Parliament for Beckenham, I dealt with a case involving a doctor who could fairly be described as incompetent, but who was not so unreliable as to be considered guilty of professional misconduct. I was surprised to discover at the time that, although local remedies existed, there appeared to be no national remedy to deal with the problem—in terms either of discipline or of finding a way to overcome the problem by imposing, for example, retraining. It was that experience that first led me to realise that there was a deficiency in the procedure.
My views were brought into sharp relief by a case which I should like to go into in detail but cannot because I have guaranteed the privacy of the individuals involved, for understandable reasons. It is still outstanding. It has been running for two years and involves what I regard as dubious practice on behalf of a member of the medical profession. The treatment provided was dubious; the way in which it was carried out was certainly dubious.
I was further alarmed to discover while investigating the case that it was by no means the first example of that member of the medical profession behaving in that way. There had been a number of examples and I believe that there have been more since—it is a continuing problem. I took the matter up with the GMC as I believed that that was a way of, if not obtaining a remedy, at least preventing such things from continuing.
Although I have to compliment the GMC on recognising that there was a problem and on being prepared to look into it immediately, at the end of the day it was not able to offer a solution because in its judgment—a judgment that I have to respect—this case did not come within its rules. The GMC suggested that I take the matter to the Department of Health, which I did. I was advised that, sadly, there was no scope for action there because nothing illegal was being done—it might be dubious, but it was not illegal.
I found that, as a Member of Parliament, there was effectively nothing that I could do to prevent what was happening. I could offer only sympathy to the people involved, which was certainly not sufficient. They decided, quite rightly, to pursue a legal remedy and went so far as to get counsel's opinion, but found that in this country, unlike in many others, there was no remedy via the courts and the legal system. I was left with the impression that complaints and disciplinary action relating to the conduct of doctors was, at least in that case, inadequate. I doubt that the changes introduced by the Bill


and the regulations that will follow will be sufficient to deal with such cases, but the Bill is at least a step in the right direction.
I have begun by criticising two members of the medical profession, but I have had considerable experience of dealing at many levels with members of the profession and I want to make it clear that I have encountered many who are of the highest quality and offer the highest standards of care, service and expertise. I do not want my remarks to be taken to mean that I am casting aspersions on the profession in general.
It is surely in the profession's interest that its complaints system operates in such a way as to inspire public confidence in the profession generally and ensures that action can be taken when conduct has not been of the highest standard. No profession is immune from having within its ranks people who are not up to the required level of competence, who are not entirely honest or who do not behave as their position requires. Such problems are inevitable because professions consist of human beings. The House should ensure that, as far as possible, there is a way to protect the medical profession's good name against the few bad cases and that public confidence can be retained. I believe that the Bill will succeed in doing that.
My right hon. Friend the Secretary of State said that, public expectations are much higher these days. That is undoubtedly true. She also said that doctors are no longer regarded as paragons. Indeed, people are much more critical now than they would have been even 10 years ago and they require a system that enables them to have their complaints about inadequacy dealt with so that standards are improved.
I am delighted that the GMC has made it clear that it supports the thrust of the changes because, of course, it is far better to reform the profession if the profession is prepared to endorse change rather than having it imposed on it. I pay tribute to the hon. Member for Newham, South (Mr. Spearing), who for many years waged a campaign to change the profession's disciplinary system. To an extent, the Bill is the fruit of his efforts, although I know that he would have liked to go further.
Given the need for swift reform, it is absolutely right that it should be carried out under the present regime of self-regulation. However, were we starting ab initio, I should not feel especially well disposed to having such a heavily self-regulatory system. I speak with some experience of self-regulation, having worked for a while in the advertising industry which operates a system of self-regulation. Although it operates well, it was clear to me that it could not provide all the answers that the public had come to expect. The system was deficient. I was also involved in the setting up of self-regulation for the direct mail industry and came to the same conclusion in that instance.
We need to ask whether self-regulation is sufficient for the medical profession. The hon. Member for Strathkelvin and Bearsden (Mr. Galbraith) spoke effectively on that point. He said that he did not believe that there was a conspiracy among professionals to cover up. I accept that judgment, but I still believe that self-regulation is open to potential criticism. Although I would not accept that there is any conspiracy or whitewash among professionals—indeed, they have reason to aspire to the highest

standards—there is clearly a danger that the profession will indulge in self-protection and use the Bill and existing legislation to be cautious, if I may put it like that, when dealing with complaints and criticism. The profession is naturally resistant to change. It does not want any further requirements placed on it in respect of discipline and standards of conduct unless absolutely necessary.
If the public are to be sure that a system is operating properly, they have to believe that everything is above board. If the public think that everything is not above board, even when it is, there is a deficiency in the system. I therefore have some doubts about self-regulation, especially in respect of the national health service, whose professionals are required to obtain higher standards than in, for example, commerce.

Mr. Malone: Before my hon. Friend leaves that point, I hope that he will bear in mind that the GMC has a substantial lay element, so it is not quite a closed shop. I am sure that he will concede that the Government are not imposing something on the profession. The GMC fought for the Bill for some time and the Government are glad to be able to support it.

Mr. Merchant: I am grateful to my hon. Friend. I said a few minutes ago that the GMC clearly supports the Bill. I was going to stress that, in any event, there is not a system of pure self-regulation in the medical profession. There is a lay element in the Acts of Parliament which gives backbone to the system and which means that the profession is not entirely self-regulating. It is self-regulation built on a statutory framework. It owes its origin to the Medical Act 1858, to which the Bill is related.
We must bear it in mind that that Act was passed at what was perhaps the peak of laissez-faire, so the system is, in essence, Victorian. I do not say that in a critical sense but simply as an explanation. The Act provided a structure in tune with health provision of the time, but times have changed considerably. The public's demands have changed, which is why the Bill is needed to update the system.
I regard the Bill as part of a continuing process. I predict that further changes will be needed in future to take account of yet more changing attitudes. I do not share the somewhat apocalyptic vision of the hon. Member for Cannock and Burntwood (Dr. Wright), who went a little far in talking about the dangers posed by problems in the medical profession. Although I understand his concerns, the Bill is pretty narrow in terms of the changes that it introduces. There will come a time when a broader framework will be required to cover not just those who the Bill covers—registered medical practitioners—but many quasi-medical professionals whose numbers are multiplying and who offer medical services that are now accepted by the national health service. Some of them are regulated by legislation, such the Osteopaths Act 1993 and the Chiropractors Act 1994, which I was delighted to support, but many other mushrooming activities in alternative health care should also be included in the legislation.

Dr. Spink: Does my hon. Friend share my concern that the public might be disappointed with what the Bill delivers? It will not be a panacea and resolve every small complaint. People may be looking for rather more. The


Bill is a move forward, but there is further distance for us to cover, particularly in improving the way in which FHSAs deal with complaints.

Mr. Merchant: I agree with my hon. Friend. He is absolutely right. It is a stage that will be welcomed, but it is a step behind public expectations. His latter point about FHSAs is also absolutely right.
The Bill's major deficiency is that it widens or deepens the authority provided by existing measures only slightly and it does not provide a comprehensive system to cover the complaints procedure via the national health service, to which my hon. Friend was referring, or the quasi or alternative medical professions.
My principal feeling is that the Bill is useful and important because it covers a surprising gap in the present powers. The average member of the public would assume that the current disciplinary system or complaints procedure covered adequacy or inadequacy among the medical professions, incompetence, constant poor performance and faulty judgment. Most people would imagine that any doctor who demonstrated incompetence would immediately be caught by the provisions of his own profession's standards and disciplinary systems. That is not the case. There is a gaping hole in provision.
The present legislation allows for what was described by the rather quaint phrase "infamous conduct in a professional respect". What, indeed, is infamy? It was, defined in 1894 by Lord Justice Lopes who said that it was conduct
regarded as disgraceful or dishonourable by the professional brethren of good repute and competency".
That is a very persuasive description, but it is not sufficient to cover poor, simple incompetence and inadequacy and, in that sense, a gap existed.
The GMC's "Proposals for new Performance Procedures: A consultation paper" went straight to the heart of that. It defines
'seriously deficient'—in other words, so blatantly poor that patients are potentially at risk".
Surely it is necessary to include in the statutory framework behind the disciplinary system that the GMC operates full scope for that to be covered. The Bill does that, and not before time.
The Bill covers the need to protect the public from deficient performance, but it proposes to do so in a way that is supportive and remedial. The first objective is to protect the public. The second objective is to try to deal with the problem positively by finding a means to raise the individual doctor's standards. Given the potential expertise, the training that doctors have to undergo and the cost, it is surely right that, if possible, a means should be found of rescuing the doctor and putting him back on the straight and narrow.
The GMC is perfectly right to do that. It recommends putting in place a procedure that will be fully covered by regulations under the Bill when it becomes an Act, local assessment and a complex system of ensuring that justice is done, even if the complaint is relatively minor.
The GMC has produced an exceptionally complicated flow chart which, when one follows it through, as I have done, is logical and ensures not only that complaints are properly screened and dealt with in the right way, at the right level and with the right degree of proportionality but

that the doctor is given adequate care and attention at each stage to solve the problem, from the point of view not simply of the complainant but of the doctor.
I do not believe that the Bill solves all the problems, but it represents an important step forward. However, I hope that my hon. Friend the Minister can reassure me on one point. It is a contradiction between the judgment of Jean Robinson, vice-president of the Patients Association, and that of the GMC.
Mrs. Robinson was quoted in The Independent as criticising the proposals for not going far enough. She said that the procedures
would involve only cases judged on poorly defined criteria to be 'serious', would operate entirely in private and would provide none of the rights to be represented or to seek a judicial review which are enjoyed by patients bringing complaints of misconduct.
Referring to the changes, the GMC document said:
They will not form a lower form of the conduct procedures. They are not aimed to attract a new category of complaint to the GMC, rather they will provide a way of dealing with many existing complaints concerning failures in professional performance.
I am somewhat puzzled by that. I hope that the Bill addresses the concerns expressed by Mrs. Jean Robinson and does not entirely reflect the GMC document.
If the Bill does nothing more than underline what is already occurring, it does not go far enough. If it goes a step further, as I understand it does, the GMC description is not entirely accurate when applied to the Bill. There is a need for a lower tier of conduct procedures. There is a need for complaints that are not caught by the existing procedures to be addressed. If the Bill operates as it should and if the regulations that follow it are sufficiently tough, that is precisely what will happen. The two new committees that the Bill sets up will do that, but I hope that my hon. Friend the Minister can give us some reassurances to that effect.
The Bill is an excellent measure and I strongly support it. I hope that it passes into law soon. I hope that the regulations that follow will be adequate and will enable doctors and medical practitioners to continue to enjoy their excellent reputation by assuring the public that there are proper procedures to deal with those who do not come up to standard and to ensure that those doctors are brought up to standard, for the benefit not just of their careers and future and those of their fellow professionals but of all the people in Britain who seek and expect the best standard of care from health service practitioners.

Mr. Nicholas Brown: On a point of order, Mr. Deputy Speaker. The excellent House of Commons Library briefing note on the Bill has so far been read to the House four times tonight. There is a rule against tedious repetition. How often do we have to hear it read to us from the Conservative Benches?

Mr. Deputy Speaker: I am well aware of that particular rule and I have been taking note. The hon. Gentleman can rest assured of that.

Dr. Robert Spink: It is a great pleasure to follow my hon. Friend the Member for Beckenham (Mr. Merchant), who always makes an interesting speech. As I expected, he demonstrated a wealth of knowledge about the subject in the course of his very cogent remarks. It is also a great pleasure to speak in support of the Second


Reading of the Medical (Professional Performance) Bill. However, my contribution will be short because, as we heard a moment ago, much has already been said.

Mr. James Pawsey: But it will not stop my hon. Friend saying it again.

Dr. Spink: I am indebted to my hon. Friend. The Bill takes an extremely small but significant step forward in driving up standards of patient care.

Mr. Pawsey: I thank my hon. Friend for giving way. Does he find it as extraordinary as I do that there is only one Liberal Member, two Labour Members and not a single Back-Bench member of the Labour party—

Mr. Deputy Speaker: Order. Let us return to the Bill.

Dr. Spink: I am indebted to you, Mr. Deputy Speaker. The Bill received all-party support, so it seems absolutely incredible and outrageous that the Opposition Benches are empty, as my hon. Friend has correctly pointed out.

Mr. Nicholas Brown: As we support the principle of the Bill—which is what should be discussed during the Second Reading—the Opposition parties are trying to make progress while Government Back Benchers seem to be filibustering unduly. I cannot understand why they are doing so, but that is clearly what is going on.

Dr. Spink: Mr. Deputy Speaker, you have been listening to the debate very carefully and you will be aware that hon. Members have raised a number of very proper questions which will be dealt with during the Committee stage of the Bill. That is why the debate has proved so interesting and useful. The Minister is taking great notice of it and he is making copious notes. I look forward to hearing his speech.
Both the General Medical Council and the British Medical Association have given their blessing to the Bill. The GMC press notice of 16 March 1995—a significant document which I have taken from the Library research paper and which I do not believe has been read to the House—states:
We identified a gap in our powers and I am pleased that Parliament has been asked to fill this gap to enable us to do our job more effectively".
That is what we are about tonight.

Mr. Congdon: I agree with my hon. Friend and we are all aware that the GMC was behind the Bill; it identified a gap in its powers. However, should we not ask whether there are other gaps that are not addressed by the Bill? There is a danger that we will pass the legislation and, in five years' time, realise that such gaps exist.

Dr. Spink: My hon. Friend the Member for Croydon, North-East makes a telling point that has been referred to before and that I will come to in a moment.
In talking about the support that the Bill has received, I must mention the important patient groups and associations which have indicated their support for the general thrust of the legislation, although they also expressed some reservations. Those reservations have been aired tonight, but in deference to the hon. Member for Newcastle upon Tyne, East I will not rehearse them again.
In welcoming the Bill, I accept that there are some difficulties in the national health service and that mistakes sometimes occur. The NHS treats millions of patients each year and it would be incredible if occasional misjudgments or even gross errors of judgment did not occur. Thankfully, such events are rare and I pay tribute to the doctors, nurses and even the health service managers, all of whom enable the health service to function properly and provide an improved service to our constituents.
Southend-on-Sea trust hospital is improving the service it provides to my constituents. It treated 17,140 more patients last year and it has treated an additional 700 patients this year.

Mr. Deputy Speaker: Order. It seems as though my remarks have fallen on deaf ears. It is very interesting to learn what is happening in the hon. Gentleman's hospital, but we are dealing with the Medical (Professional Performance) Bill. I ask the hon. Member for Castle Point (Dr Spink) to address his remarks to it because we are nearing the point of tedious repetition.

Dr. Spink: I am indebted to you, Mr. Deputy Speaker. The Government have raised public awareness that taxpayers should expect good, timely and courteous service from all areas of the public sector, including the national health service. The Bill addresses that point very directly. The Conservative Government have raised patient expectations. The hon. Member for Cannock and Burntwood (Dr. Wright) outlined many of the ways in which patients have received more information and more rights, so I will not repeat those points.
The citizens charter movement was initially scorned by Opposition Members, but it is now being studied and copied across the world, for example, in the United States. Tonight hon. Members have referred to a number of alarming cases involving serious neglect in the health area. The Bill should swing the balance of health care in favour of the patient while dealing with problems that occur from time to time in the health service. It will provide patients, the BMA and the GMC with another weapon in their armouries. The hon. and learned Member for Montgomery (Mr. Carlile) referred to that point in welcoming the legislation during debate about the Queen's Speech.
My hon. Friend the Member for Wyre Forest (Mr. Coombs) said eloquently that patients have responsibilities as well as rights and he referred to patients' increasing tendency to abuse those rights. People are making more night calls and they are constantly referring matters of little significance to their doctors. That is placing a burden on the system, doctors are being placed under greater pressure and that is leading to an increase in the number of mistakes that they make. I hope that we will look carefully at ways of inhibiting that development.
A story appeared on the news tonight about a doctor who worked 110 hours. He successfully sued his local health authority and received about £5,000 compensation because he said that he had been put under undue pressure and was therefore at risk of making a mistake in treating patients. If he had made a mistake which had amounted to gross incompetence, the Bill would have swung into effect and enabled him to receive additional training so that he could provide his patients with better care. That is one of the reasons why I support the legislation. We


accept that patients have needs and rights and that they should receive the best possible protection from incompetent doctors.

Mr. Pawsey: I thank my hon. Friend for giving way and I apologise for interrupting the flow of his speech. He is making an extremely eloquent speech which I know will be noted carefully by all those hon. Members who are in the Chamber and by those who will read Hansard in due course. Does he find it surprising that there is no reference in the Bill to the work of the health service commissioner? My hon. Friend assiduously attends debates in the House and he studies such matters with the utmost care. Therefore, is he surprised that the Bill does not mention the work of the health service commissioner and the way in which he may hear complaints relating to general practitioners?

Mr. Deputy Speaker: Order. That was a mini speech, not an intervention.

Dr. Spink: I am indebted to you, Mr. Deputy Speaker. Although it was a rather long intervention, it was an interesting and important one. Of course, the health service commissioner plays a pivotal role in these matters, and I look forward to hearing what my hon. Friend the Minister has to say about that when he replies.
Whatever the reason why a doctor might be incompetent—the hon. Member for Strathkelvin and Bearsden (Mr. Galbraith), himself a distinguished medical man, gave a very illuminating account of the various reasons, so I shall not rehearse them—he or she should be given the opportunity to recover and repair. The Bill allows time for that process to take place. The Bill leads the way, therefore, to improving standards of doctoring by allowing time for doctors to retrain. It gives them one or two years—perhaps more—to retrain and represent and be relicensed, so that they can continue their profession. That is absolutely right. The Bill is not just about discipline and punishment. It is focused on driving up the standard of care that patients can expect to receive from their doctors. That is the way it should be.
On a technical note, my hon. Friend the Member for Ribble Valley (Mr. Evans), who made a most interesting and cogent speech, referred to the costs of retraining and asked whether they would come from the general NHS budget or from any other hypothecated budget. The explanatory and financial memorandum to the Bill said that the cost to the NHS of retraining doctors, as a result of the Bill's measures, would amount to about £530,000 each year. I do not think that we should consider that cost as unacceptable or, indeed, that it is an unacceptable demand on the health service budget, as sound benefits will flow from that relatively small expenditure.

Mr. Peter Atkinson: I am grateful to my hon. Friend for giving way. What happens if the doctor involved is not a practising doctor but simply works as a locum and moves around the country? What happens, for instance, if that doctor was in private practice? Which section of the NHS does my hon. Friend think would have to cover that cost? Would the local family health service practitioners committee have to foot that bill, even though the doctor was in no way attached to it? There is a problem there.

Dr. Spink: These are all extremely interesting and important questions which my hon. Friends on the Front Bench will be addressing—

Mr. Malone: indicated assent.

Dr. Spink: I have seen the nod of the head. I, like my hon. Friend, look forward very much to receiving the explanation about that and perhaps to reading the deliberations of the Committee, which, no doubt, will go into this with a fine-toothed comb.

Mr. Pawsey: Once more I apologise to my hon. Friend for interrupting his speech. I draw his attention to clauses 5 and 6. He will be aware, because quite clearly he has studied the Bill in considerable depth, that clause 5 provides that an
Order in Council may bring different parts of the Bill into effect at different times.
Yet clause 6 says that the Bill
will extend to the whole of the United Kingdom.
Does my hon. Friend agree that perhaps there is an argument for some form of pilot scheme to be introduced, perhaps, for example, into Scotland, to see how the Bill operates and to sort out any teething troubles? I would welcome his advice on that point.

Dr. Spink: My hon. Friend has clearly assiduously read the Bill, has taken in all its clauses carefully and is considering them. I believe that it is such a good Bill—it takes an important step forward in its contribution to improve patient care and helps doctors who are having problems to recover from those problems in an honest and honourable way—that it should be brought in without a pilot, as soon as possible. No doubt those items can be deliberated on at length in Committee.
I was talking about whether the £530,000 cost of retraining doctors is acceptable or whether it would be an unacceptable burden on the health service, and that benefits would flow from that expenditure and that it was relatively low. The increased effectiveness of doctors as a result of the expenditure on their retraining, and the better diagnoses that they would make, would deliver massive benefits that would far outweigh the very small cost. I do not think that the cost is of any great significance. I believe that it would be money extremely well spent.
I agree with other hon. Members, particularly my hon. Friend the Member for Croydon, North-East (Mr. Congdon), that we need better systems to deal with chronically poor doctors—those who make small mistakes from time to time, who need a small amount of help—rather than the very serious bad performance and outrageously bad professional conduct, which, in a way, are easier to deal with. The Bill addresses those more directly. We cannot avoid the problem of the chronically poor performance, and we must find systems and improved ways of dealing with that.

Mr. David Lidington: Has my hon. Friend studied the precedent set by the Osteopaths Act 1993 and, dare I say it, the Chiropractors Act 1994, which provide for penalties in respect of conduct by a practitioner that falls short of the standard required of either a registered chiropractor or osteopath respectively? Does my hon. Friend believe that those might serve as useful precedents


that the Government might study with a view to introducing something not dissimilar with regard to the orthodox medical profession?

Dr. Spink: My hon. Friend makes an important and interesting point, which no doubt will be considered carefully. He comes to the House with a lot of knowledge and has done a great service to society at large through his work with the Chiropractors Act. We pay tribute to him now.
I shall give a specific example of a chronically poor performance. It has not been covered before. You will not be aware of it, Mr. Deputy Speaker, but there has been a lot of repetition tonight, and I deplore that. Indeed, I am trying to avoid it. The example is one of a doctor who falls out with a patient—perhaps there is a personalty clash, or whatever—and decides to remove that patient from his list, but refuses to give a good reason, or any reason, for so doing. The GMC will not take any notice. It is not terribly interested. I have tried to interest it in a difficult case in my constituency, but it has not shown any willingness to become involved. The FHSA sometimes finds that it cannot be of much help. Doctors in the area talk to one another. Other doctors are reluctant to take on the patient. As a result, the patient, who herself was damaged as a result of the medical profession making a bad decision in the first place, may well be causing a nuisance to the doctor.
But that is the nature of it. Many of our constituents cause what might be considered a nuisance to us. They have every right to do that. That is what we are paid for, and we must accept that and deal with it in a proper and professional way. We cannot turn our backs on our constituents, and we do not. Doctors should not turn their backs on their patients, but some of them do. I doubt whether the Bill would deal with that. The committee on professional performance, which is mooted in clause 1 of the Bill, would not be able to deal with that. It would not consider it to be any great professional misconduct issue that it should deal with. Gross misconduct or serious deficiency in performance would not cover the removal of patients from a list. So we have—

Mr. Deputy Speaker (Mr. Michael Morris): Order. I can help the hon. Gentleman. If the Bill does not cover the illustration that he is giving, I am afraid that he is out of order. If he thinks that it might, he would be in order.

Dr. Spink: I am greatly indebted to you, Mr. Deputy Speaker; you are absolutely right. However, perhaps we should consider whether the Bill should be extended to cover that matter. I think probably not; the Bill should go forward as it stands because it is an extremely good Bill and we should not delay it. We need to consider other measures to follow behind it. I note that you are leaning forward in your Chair again, Mr. Deputy Speaker, so before you stand up I shall sit down.

Mr. Peter Atkinson: I apologise to the House because although I was here to listen to my right hon. Friend the Secretary of State's introduction to the Bill, unfortunately I then had to attend meetings elsewhere

in the House and so missed what has clearly been a long and interesting debate. I hope that in my few remarks I shall not be unduly repetitious.

Mr. Nicholas Brown: Only someone who has not attended the last two hours of debate could possibly describe it as interesting.

Mr. Atkinson: I do not think that I should be tempted to reply to that comment—although I must point out that I hold the Bill in my hand, not the research document from the House of Commons Library.
I join in the general welcome for the Bill, which is an important measure that will do a great deal to improve medical standards in this country. It should be made clear that the Bill is in no way a criticism of the national health service or of doctors. We should say time and again, even at the risk of being repetitious, that Britain has a first-class health service and that the majority of doctors and medical practitioners are of an excellent standard and take great trouble about retraining and keeping up to date with modern trends in medicine.
The Bill is a kind Bill. It is not intended to attack or harry general practitioners who may fall foul of it. Instead, it makes provision to retrain them, to support them and to bring them back into the fold as competent doctors.
I want to pick up a point made by my hon. Friend the Member for Beckenham (Mr. Merchant) about there being some gaps in the Bill. I do not want to be out of order, Mr. Deputy Speaker, but I must say that I believe that in time we will have to extend the process to developing areas of medicine such as chiropractors—something that my hon. Friend the Member for Aylesbury (Mr. Lidington) knows a great deal about—or even bone setters, as they are known, who are increasingly moving into a quasi-medical position.
I speak from a position of considerable luck because I represent a rural constituency. It has isolated communities, but within them there are first-class medical practices, health centres covering most of the constituency and an excellent general hospital. I am sure that the provisions in the Bill will not need to be applied to any doctor in my constituency.
One concern that I have about the Bill is the effect that a vindictive patient might have on a perfectly competent GP. I know that the Bill provides for a screening system, but I am concerned that an individual GP could be dragged before a committee time and again simply because of complaints from a troublesome nuisance patient. As patients learn more and more about their rights—as they should—the odd troublemaker might seek to pursue a vendetta against a GP.
There is also the question of who pays for retraining. That issue should not be left in the air. I appreciate that one of the problems with such a short Bill is that a great deal of the detail is to be left to regulation, which I understand must be approved by the Privy Council. That always causes Members of Parliament to feel slightly ill at ease because we are being asked to approve a Bill that is not complete.
The question of who pays for retraining is important. Doctors may be self-employed, but usually they are employed by the family health services authority. There are also some peripatetic locums who move from one position to another. Who would be responsible for retraining those people? I do not think that the local health


authority or the hospitals should take on that retraining. I hope that my hon. Friend the Minister will respond to that point when he replies.
Another point that needs consideration is the appeals procedure. The Bill is complicated, but my understanding is that if a GP felt that he had been wrongly convicted—that is perhaps not the right word—his only recourse would be to the law. There is no opportunity for an accused doctor to disagree with the screening process or the professional judgment of his peers. I wonder whether there should be such a gap in the Bill.
Will the hearings of the General Medical Council's committees be held in public? The GMC's proceedings are usually open to the public. One difficulty could be that, much to the delight of the tabloid newspapers, marvellous stories about doctors in trouble with their patients could be splashed across newspapers—even though the allegations are often totally unfounded. Will doctors who have to appear before the GMC committees be granted privacy when their cases are heard?
Despite those few reservations, I very much welcome the Bill. I hope that the details in the regulations will be more thoroughly discussed in Committee because, as I have said, there is a slight feeling of ill ease that such a short and compact Bill should rely on other people adding to it to make it work.

Mr. Robert Key: I was detained at the start of this afternoon's business, so I look forward to reading the early part of the debate in Hansard. I want to raise some important issues which I do not think have been covered in earlier speeches.
Over the years, Members of Parliament have to deal with many cases in their constituencies. Some can be easily resolved, but more usually they cannot. When a professional conduct case is involved, it is usually beyond the competence of a Member of Parliament to make a judgment, any more than a Health Minister can make a judgment on a clinical matter. That is no different from the behaviour that the British people would expect of lawyers, accountants or any other professional person. It is the whole essence of professionalism. Standards apply to a profession and we expect people in that profession to maintain them. I was fortunate enough to be a teacher for 16 years before I entered the House and I learned the essence of professionalism in the world of teaching.
The cases with which we have to deal as Members of Parliament vary widely, and sometimes we are fortunate enough to gain some professional insights. I served as a member of the Medical Research Council, where I saw what many would regard as the rather esoteric end of the market. However, it gave me an enormously important insight into the challenges facing the medical profession, both in this country and elsewhere.
Some of the cases that our constituents bring to us turn out to be not quite what they seem. That is why I warmly welcome the Bill. It will help us in our role but, above all, it will help citizens who feel aggrieved and it will help those members of a profession who may occasionally have unwarranted charges made against them. Sometimes cases are brought before us and there is incomplete information. A patient is aggrieved, he disbelieves his GP and he wants to take the matter further. Only a few weeks ago, I was told of a constituent whose mother had

allegedly died of bed sores in hospital. Of course that was not the position, but the relatives felt aggrieved. I regret that the symptoms were much more serious, but, all told, it was a hard time for the family concerned.
There is the occasional malingerer and the occasional example of a night-time call-out when a doctor reluctantly gets out of bed and travels miles in rural constituencies. Like my hon. Friend the Member for Hexham (Mr. Atkinson), I represent a rural constituency, and I know how it must feel. No doubt, doctors there can incur the wrath of their patients when appearing less than enthusiastic at the prospect of a journey of some miles to visit someone who is unwell. In all those cases, the patient may feel aggrieved, and occasions may arise when professional misconduct takes place. Generally speaking, however, that is not the case.
The danger involved in politicians talking too much about the issue is that they give the impression that professional misconduct is commonplace when the reverse is the truth. In my experience, it is extremely exceptional to have any serious case—the sort of case that might be covered by the Bill in relation to professional performance in the medical profession. We should be careful.
We need to deal with one or two other issues, on which I should be grateful for the advice of my hon. Friend the Minister. The first involves the question: what do we mean by "professional conduct?" One of the things that has interested me in my constituency is the improvement in the past decade in medical services provision focused on the village health centre. That has made an enormous difference to the quality of life in general, and particularly to the medical quality of life for tens of thousands of my constituents.
A substantial building programme has taken place. There are more than 100 villages in my constituency, many of which boast a good primary health care facility. The financial arrangements under which those health centres have been built put a considerable responsibility on the professionalism of doctors who are partners. Does the Bill and the concept of professional performance extend to the financial management and responsibilities of those health centres?
Should something go wrong with the complicated mortgage structure of some of those centres, might professional performance be called into question? Would it bring the profession into disrepute if, for example, a partner who had gained substantially because of the capital increase in the value of the building made off with the loot, so to speak, in a way that might be regarded as underhand?
I have no evidence that that has ever happened, but, as primary health care increasingly receives substantial sums of money from the taxpayer, it is not unreasonable to ask whether professional competence in the medical profession extends not just to the service and the bricks and mortar of a practice, but to the extremely expensive software and computer equipment, and to the ancillary staff, who are so important in an advanced health care system such as we have now. That issue should be explored.

Mr. Lidington: I find myself in considerable sympathy with my hon. Friend's line of argument. Does he think that, when dealing with conduct, the Committee that will be appointed after, I hope, Second Reading is given to the


Bill, might amend the Bill to include a clause on conduct falling short of the standard expected of a doctor, much akin to the clauses already included in the Osteopaths Act 1993 and the Chiropractors Act 1994?

Mr. Key: My hon. Friend raises an important issue and I tend to agree with him. For example, clause 1 refers to the committee on professional performance finding that a fully registered person has been "seriously deficient", but in what respect? That needs to be explored in Committee. I have no doubt that it will be, and it is important that it should be.

Mr. Lidington: Again, the two Acts to which I alluded and which relate to professions that complement orthodox medical practice have something to teach us. They distinguish between incompetence in the practice of the medical discipline concerned and misconduct more broadly defined. The Chiropractors Act, for example, refers to someone being found "guilty of professional incompetence" and distinguishes between that and
conduct which falls short of the standard required of a registered chiropractor".
That distinction is already embodied in those two Acts and Ministers might wish to consider it in Committee and during the Bill's later stages in the House.

Mr. Key: Paragraph 9 of the schedule to the Bill, states:
In Part III of Schedule 1 (Committees of the General Medical Council) after paragraph 21, there shall be inserted the following paragraphs".
They mention the assessment referral committee and the committee on professional performance. Even that, however, does not really help us or get us far. I dare say that my hon. Friend the Minister will have some answers for us on what exactly is meant by professional performance. There was perhaps a danger in assuming that, when the General Medical Council identified a gap in its responsibilities, that gap would be easily filled. It may not be easy even to decide what the gap is, let alone whether the Bill fills it.
As I have said, any professional misconduct by the medical profession is exceptional. I, too, pay tribute to the high standards in the national health service. I have always relied on it. I have no interest to declare as a subscriber to a private health scheme because I am not. The only private insurance that I have is with my dentist, who decided voluntarily a couple of years ago that he wanted to go down that road. He made the right decision. It proved good value for money for my family because, apart from anything else, as someone who only last Saturday reached his 50th birthday, my teeth are pretty rotten, and my three children have, I think, one filling between them, so the dentists will do themselves out of a job if they are not careful. I have no financial interest in the matter. I and my family believe that the NHS is superb.
I have come across one serious and tragic case. I shall not refer to it in detail because it is still running, and I fear that it will run and run. It involves the death of a child. That constituency case has brought home to me the gravity of professional misconduct or, indeed, misjudgment and it has led me to examine in some detail exactly what happens to a member of the medical profession when something goes wrong.
Again, lest it be assumed that the Bill has identified a gap that we can easily fill, I draw the attention of the House to the fact that, with the increasing complexity and technological involvement of the medical profession, it is sometimes very hard to identify which link in a chain might be at fault or, indeed, guilty of professional misconduct.
It is clear that there is a chain of many links and that things can so easily go wrong. In my constituency case, for example, when the child was first taken into hospital the nurses perhaps did not examine the child as quickly as they should. At that time there was not an absolutely standard procedure laid down for all cases in which a patient suffering from suspected poisoning was brought into the hospital. So time was lost. A doctor was not fetched by the nurse. The pathology department was short staffed because it was a Saturday. Part of the kit was unavailable. A computer link to another hospital north of the border was down because of a technological problem and, again, it was a Saturday. And the consultant was not fetched early enough because the earlier steps had not been followed.
The independent professional review revealed that one person could not clearly be held to blame. There was a series of deficiencies in procedure. Not only the medical profession but the administration was at fault because no administrative procedure had been put in place to cope with the situation in the first place. Moreover, the case was not brought to the attention of the chairman of the trust until nearly two years after it all happened.
Cases in which there may well have been some professional misconduct can sometimes take a long time to investigate, and justice is therefore harder to apply. There is a long chain between the patient, the administration, the nurses, the junior doctors and the consultants.

Mr. Peter Atkinson: My hon. Friend has fixed on a particular point. He mentioned the business in clause 1 about where professional performance is found to be seriously deficient. In the example that he has described, would he say that any one of the doctors could be called seriously deficient?

Mr. Key: Yes, I would, but that is not for me to judge. That is precisely why the General Medical Council exists. It is a serious point. The length of time between the incident which led to the death of the child and the revelation of what had gone wrong meant that junior hospital doctors had moved on to other jobs elsewhere in the country. So the national health service trust in which the incident occurred was not in a position to discipline the juniors involved in the case. We therefore return, despite the chain, to the need to have a General Medical Council and for it to have adequate procedures. That is why I support the Bill, despite my reservations.
The case in my constituency is not over. That is why I have not referred to it in any more detail. The overriding problem for me is, first and foremost, the enormous distress to the parents that things went wrong and justice was not, at least in their eyes, seen to be done. Secondly, there is the enormous strain on the medical profession. It was not a case of a criminal being identified by a jury and retribution being meted out. It was not like that at all. It was a case of deficiencies on the part of very professional people who had been victims of consequential events. Misjudgments were made. The independent professional


review pulled no punches: it said that notice should be taken of some things that some nurses, some junior hospital doctors and some consultants had done. We are not at the end of that particular story.
We should not treat the Bill lightly and simply assume that it will plug the gap which even the General Medical Council has identified. We are dealing with unusual circumstances here. Of the many thousands of cases with which hospital doctors and consultants cope every week and every month, in only a tiny handful do things go wrong.We must ensure, first of all, that the likelihood of things going wrong is minimised. Secondly, we must ensure that when they do go wrong, the machinery exists to put them right without victimising people or stigmatising professionals who have not been guilty of any misconduct.
The provisions in the Bill buttress a system which is quite exceptional in that it leads right up to the Privy Council for appeal. We should be immensely proud of that because it means that we regard the professionalism of medical people in this country as of the highest importance. That means that we have not only the best health service in the world, but the highest standard of doctors. That is why people want to train in this country.
It is the duty of the House to ensure that we support the Bill so that the highest professional standards will always be maintained and the reputation of medicine in this country will be one of which not only we but the whole world may be proud.

Mr. Nigel Spearing: I whole-heartedly endorse the closing remarks by the hon. Member for Salisbury (Mr. Key). Indeed, I find myself, uncannily, in an almost parallel position. I too had 14 years in education and had to deal with a lot of pupils, families and illness. I probably share the hon. Gentleman's approach to Parliament. Fortunately, the Bill has no party or even any national health service content in principle at all. It is Parliament doing its job for the public.
I too, unfortunately, had a constituency case involving the death of a child. Instead of a chain of unfortunate circumstances, as the hon. Member for Salisbury described, my case concerned one general practitioner who was clearly and very badly wrong. Justice was not done and it resulted in an identification of the gap that we are hoping to fill with this Bill. I too have reservations about the Bill. I cannot say that I support it wholeheartedly. It is good that there is a Bill, whether it be this Bill or the procedures that have been outlined I am not quite so sure, for reasons that I shall now make plain.
I have one other thing in common with the hon. Member for Salisbury and that is being late for the debate. I am very sorry that I was not able to hear the opening speeches. Some hon. Members will know why and others will find out why if they look at today's Order Paper. The Select Committee on European Community Legislation sat for three sessions in Brussels today with Commission personnel and our ambassador there. All the discussions were about 1996 and the change. I have been trying and have managed, through the good offices of colleagues, to be in two places in different countries at once.
This debate is about the regulation of a very important profession—such matters, incidentally, of course also relate to education—which needs protection. Obviously,

anybody who is in a critical position—such as a medical practitioner, a nurse or a combination of nurses and doctors—may always be blamed. It is a natural reaction. But we also have to protect the public. This Bill and the Medical Act 1983 to which it is attached should mark that proper balance. Parliament on behalf of the public must strike that balance.
Such a balance was struck in the Merrison report of April 1975, which is worth putting on record. Paragraph 10 reads:
We have suggested that the regulation of the profession can be looked upon as a contract made between the public and the profession. It is important to understand in this context that the GMC is merely the instrument for the proper supervision of this contract and that it derives its authority, and its being, from legislation. The legislature—that is, Parliament—acts in this context for the public, and it is for Parliament to decide the nature of the contract and the way it is to be executed.
That sums up the spirit of the debate and what we are about.
The trouble is of course that in respect of Alfie Turner, there was no justice, or any for his family. He was a lad from Canning Town who, 12 years ago now, died tragically. He may have died anyway. The case is well known. The great bravery of Mrs. Stafford from Silvertown is also well known. At some risk to herself, she shopped the doctor concerned after the General Medical Council did not deal with him properly.
That deficiency in procedure prompted my private Member's Bill, which has been before the House for nearly 10 years. The GMC has not accepted it, but it has helped to promote the long discussions and detailed consultation in the medical profession, which has resulted in this Bill.
My private Member's Bill was supported, among others, by Dr. Maurice Miller, a former Member of Parliament who is known to many Members present. It was also strongly supported by the hon. Member for Cambridgeshire, South-West (Sir A. Grant), who has joined me to table a motion to refer the Medical (Professional Performance) Bill to a Special Standing Committee.
As many hon. Members have said, this is not a simple matter. I suggest to the Minister that the procedure of taking evidence and deliberating in such a Committee prior to the formal Standing Committee, which is now available to us, is tailor-made for considering this sort of important relationship between a profession and Parliament. I hope that the motion will be given due consideration. The Government Front-Bench do not have to do anything, but must merely say nothing if I am able to move it. Perhaps we will have better legislation as a result.
My private Member's Bill had the support of the right hon. Member for Peterborough (Dr. Mawhinney), the Secretary of State for Transport, who was then a Back Bencher and who knows a thing or two about medicine. It was also supported by my hon. Friend the Member for Strathkelvin and Bearsden (Mr. Galbraith), who is an eminent consultant.
I am unable to give the Bill under consideration direct support because, as I explained when I moved the Second Reading of my private Member's Bill on 3 March 1987, there is a lacuna in the present procedure for what we might call conduct and discipline. Under the present arrangements, a doctor must be found guilty of what is


termed serious professional misconduct, even if he is to be put on conditional registration, which is the main feature of the performance procedure.
I want to question the link—there must be one—between conduct in one incident and a general level of performance. Perhaps it is easier to assess it from one incident than from a period in which there has to be a serious deficiency in performance.
The word serious is very flexible. It gave rise to the terrible situation in the Alfie Turner case, when Dr. A was not willing to examine or treat the boy, or even call for an ambulance when he was virtually unconscious, and would not even take his temperature. Alfie Turner died of meningitis three days later. The doctor was found not guilty of serious professional misconduct and walked out of the General Medical Council with only a stain on his character. The GMC did not even have the power to put him on conditional registration. My Bill, which has not yet been accepted, would have allowed it to do so.
Enough of my Bill because we now have a Bill before us and that is very important. We should have some reservations about it, however. The first reservation should be about its format, as it has three or four principal clauses, which will trigger off a complex procedure. It took me quite a long time to fathom it out in the official documents. The procedure is not contained in a single diagram but in three diagrams of some complexity. No doubt those familiar with the GMC and the medical profession will be able to understand it. That complexity is another reason why we should study the Bill in a Special Standing Committee for three days, as we are allowed.
My second reservation concerns the screening procedure and I am sorry that I was late today as I know that one hon. Member present knows about it. I should have thought that it was controversial to have a single screener, or a screener with reference to just one other person. The process of screening complaints from any quarter will be replicated in the parallel procedure for performance, currently found in the realm of conduct. I have heard it said—we shall no doubt find out in Committee whether it is correct—that members of the GMC's preliminary purposes committee cannot consider cases which the screeners have already dismissed. That may have been changed by now; if not, I hope that it will be changed because it is not good procedure.
Those of us who have been in local government or on Committees of the House know that a chairman's action can be looked at and, even if it cannot be reversed, it can at least be revealed or further endorsed. Unless someone in such a crucial position is open to subsequent inspection, the public have cause for concern. Under the procedures to be adopted, the decisions of one or, at most, two screeners should be open to subsequent examination. After all, if someone writes to a member of the GMC and asks why a case did not come before it, that member should at least be able to look at the case, perhaps in confidence, to see why it was dropped. I do not think that can happen now.
Since introducing my Bill, I have received many letters about delays from all over the country. If someone complains to the GMC, it naturally puts the matter off if the complaint has gone to the family health services authority or one of the learned colleges of medicine. That

may be all right, but I have heard many examples where complaints have been brushed off, and the GMC's public relations in that respect do not always induce public confidence.
I have referred to the complexity of the diagrams on procedure. I make no specific complaint that the performance procedure as distinct from the final stages of the disciplinary procedure are held in private, as there may be an argument for that. The problem is that, once a complaint has been considered, and even after the screeners have said that there may be a case, the complaint can be dropped in at least three subsequent parts of the procedure before it reaches the proposed statutory committee—the assessment referral committee—and will not necessarily reach that committee at all. Although there may be nothing wrong with that, if it is not open to GMC members to consider those complaints, the public have cause for concern.
The hon. Member for Salisbury mentioned appeal to the Privy Council. That is confined to the conduct line of investigation but will be complicated if we are to have two parallel forms of investigation. Although the conduct of a doctor who is guilty of a criminal offence or some other misdemeanour that is not medical must be investigated, we now have no less than four committees: the preliminary purposes committee; the professional conduct committee; the assessment referral committee; and the assessment of professional performance committee. We also have the possibility of appeal to the Privy Council. Unless what is happening in those investigations is crystal clear and open to an extent, even if doctors are anonymous, I fear that difficulties may arise.
I should like to refer to the financial memorandum at the beginning of the Bill. I do not think that we should necessarily worry that doctors who are recommended for some form of retraining should receive it at public expense. I am not sure that that is correct, unless they are employed by the NHS, but I do not want to pursue that. I am interested in the estimated sum, because I cannot understand how it was arrived at. Perhaps the Minister will be able to tell me that when he replies. How do we know how many doctors will go through the retraining process? What standards of serious defective performance will be set by the various committees? How many doctors will be eligible for some sort of retraining or other acceptable courses before they reach the later stage in the retraining process? I cannot see how it was possible for anyone to make a realistic estimate of the amount contained in the financial memorandum. The sum will be paid per annum at the current cost, so what will happen later?
I am not arguing that it is wrong to give money for the retraining of doctors, but someone with a great deal of relevant experience said to me, "By George. Many of these doctors are getting on a bit and haven't kept up." I wonder how capable they are of benefiting from the sort of courses that will be offered. Such doctors may need something more, such as support from their colleagues, or something more subtle than a retraining course. We should ask a lot of questions about those financial arrangements.
I referred earlier to the format of the Bill and I should like to do so again, because of the procedural implications more than anything else. Although the Bill has relatively few clauses, designed to amend the Medical Act 1983,


the schedule to the Bill contains about 50 amendments—I accept that some may be minor—to the 1983 Act. Apart from the clauses, the schedule contains two chunks of amendments to be incorporated in the amended 1993 Act. I reckon that those amendments will create a few new complex sections in that Act when they are either laboriously changed in ink or in "Halsbury", or some computer has a go at it.
It might be worth while—it may be dealt with in another place—if the relatively few sections in the Act relating to doctors' performance were repealed and replaced by an entirely new section. It would be rather like replacing a unit in a complex piece of electronic machinery instead of trying to tinker with it by changing just odd parts. The meaning of the amended Act would then be clear. Unless that is done it will be extremely difficult to follow the new law. That might mean a feast day for lawyers, doctors and the Medical Defence Union, but it would not be right for us to leave legislation in such a tatty state.
The MDU expressed an interest in my amending Bill. I wrote an article about it in the Journal of the Medical Defence Union issue number one of 1991, in which I said:
The Bill in essence is as much in defence of the reputation of the profession as a whole, since it would promote confidence in it that doctors deserve and the public have a right to expect.
I suspect that that principle should be applied to the 1983. Act, as amended by the Bill, as much as to my own honourable effort.
I called my Bill the Turner-Stafford Bill because it was dedicated to two constituents; one, alas, dead while the other lady is still alive. One of the biggest lacunae in today's Bill is its failure to match what my private Member's Bill sought to provide.
Here we have two streams of procedure, a conduct procedure and a performance procedure. There is a triangle, and if one of the preliminary screeners says, "This is conduct; we ought to do this through the conduct leg of the procedure," and the procedure goes through as it did in the case of Dr. A, and in the end the doctor is found guilty of not having done this, that or the other, but his omissions are not considered to have amounted to serious professional misconduct, he cannot even be put on conditional registration. That is what happened with Dr. A.
If, on the other hand, the person controlling the original king points—the first screener—says, "Let us do this under the performance procedure," the case goes all the way through the performance channel and the committee says, "Dear, dear, there has been a serious lapse in performance here," the doctor will get retraining or be put on conditional registration. I consider that the better way of describing it, because the result should be remedial, not penal; we want remedies but not necessarily penalties. In that case the doctor would get something that it would be impossible for him to get under the present law if the case were dealt with under the conduct procedure.
Paraphrasing the legal language, my Bill simply said that if what a doctor had done did not amount to serious misconduct, but was nevertheless conduct unacceptable in a medical practitioner, the GMC would have the power to put him on some sort of conditional registration, however mild. The exact details could be tailor-made for the situation.
However, the GMC said that it did not want those powers. I now suggest—and I shall take the matter up in Committee—that if such a situation arises the conduct committee, which already exists, should have the power to refer the case back to the performance committee, saying that there had been no serious professional misconduct but that there had been a lack of performance. That would amount to what my Bill would have brought about. Although the GMC was against the idea at the time, I hope that it will reconsider.
The suggestion could form the basis of one of the amendments that we make to the Bill in Committee. I hope that the Committee will be that suggested in my procedural motion, which I hope the House will support as the most appropriate way of dealing with this important Bill, which not only affects all of us as members of the public, but affects all our constituents and also the noble profession of medicine.

Mr. Nicholas Brown: With the leave of the House, Mr. Deputy Speaker, I should like to respond to the debate—briefly, because I know that we are all anxious to hear the Minister's responses to the questions that he was asked not once but many times.
In my opening remarks I was uncharitable enough to observe that the governing party was padding the debate out and to allege that that was done to avoid exposing the Secretary of State to more contentious debates on health care. The debate has provided a fair amount of evidence to support that contention; it has been good-natured and well-informed, if somewhat repetitive.
The first Government Back Bencher to speak was the hon. Member for Birmingham, Edgbaston (Dame J. Knight); she was the first of several hon. Members to pay tribute to my hon. Friend the Member for Newham, South (Mr. Spearing) for the part that he has played over the years in repeatedly trying to bring before the House the issues addressed by the Bill.
The hon. Lady praised my hon. Friend and his supporters on both sides of the House for their endeavours, and she also mentioned the meningitis case to which my hon. Friend referred. Her words found widespread acceptance in the House when she asked what we could do about a doctor who said that he could not be bothered to see his patient. I must admit that I am pretty sceptical about how much retraining would help in such circumstances, yet retraining is a key feature of the Bill.
The hon. Member for Edgbaston expressed a fear that our health service would approach the American model and become more litigious. I agree with what she said about that, although I fear that the Government's national health service reforms take us in that direction, rather than help avoid it.
In a powerful contribution, my hon. Friend the Member for Newcastle upon Tyne, Central (Mr. Cousins) delivered himself of a highly critical and well thought-through critique of self-regulation. The Government have made it pretty clear that it is the legislation before us, amended as best we can in Committee and on Report, or nothing. They are not considering a more radical reform of the profession or professions.
My hon. Friend the Member for Newcastle upon Tyne, Central expressed uncertainty about the use of language in the Bill. He concentrated on the meaning of the word


"serious" and mentioned the number of procedural stages and the influence of old boy networks. The argument about language was well taken up by my hon. Friend the Member for Strathkelvin and Bearsden (Mr. Galbraith), who made a similar argument, although about the word "competence". Both words are important. Obviously, the way in which those terms will be defined in practice will set the standards for the profession, and it is right that we tackle those issues now and in detail during consideration in Committee.
That brings me to the contribution of the hon. Member for Chislehurst (Mr. Sims), who told us helpfully and fully of his work on the PPC. I pay tribute to him for that work. He rightly spoke of the importance of the laity in the work of the General Medical Council. However, although he expressed support for the principle of the Special Standing Committee procedure, which Labour Members would like to be followed in that case, he said that he did not consider that it was applicable in those circumstances, because there had been such widespread and thorough consultation.
I am sure that what the hon. Member for Chislehurst says is true, but let me say to him, as gently as I can, that Members of Parliament, especially members of the Opposition, have not been a part of that consultative procedure. If legislation is to pass through this place, it is for the elected Members of Parliament to satisfy themselves that the legislation is properly structured—not for all the outside interests to be so satisfied, and to come to Parliament and treat us as though we were a rubber stamp. Our constituents would not want us to be treated in such a way, and it would be demeaning to this place if we ever allowed ourselves to be treated in such a way.
I advocate crisp but mature scrutiny of the details of the legislation, once concise expert opinion has been heard—the same concise opinion to which people in the profession have already been exposed. I consider that that would serve Parliament better than the adversarial Committee procedures that I believe are the ones that the Minister favours—although I wait to be surprised and perhaps even encouraged.
I make the Minister an offer. I guarantee that, if the procedure that we wish to be adopted is accepted, we shall co-operate fully with that procedure and the Bill will not be unduly delayed. Indeed, that promise was made to him during the Queen's Speech by my right hon. Friend the Member for Derby, South (Mrs. Beckett).
The hon. Member for Wyre Forest (Mr. Coombs) got his teeth into the briefing notes so ably prepared by the House of Commons Library, although he diverted from them to accuse some patients of unreasonably becoming ill, thereby placing pressure on the national health service. [Interruption.] I hope that I do not do his contribution an injustice, although I hear from the groans of his hon. Friends that I may have paraphrased him unfairly. It is nevertheless the case that there is increasing pressure on the national health service, which shows up in the statistics for complaints and in the much smaller statistics relating to the GMC's ability to cope with complaints.
We had a powerful contribution from my hon. Friend the Member for Cannock and Burntwood (Dr. Wright), who discussed the extent of the powers in the Bill, made the case for the Special Standing Committee procedure

that we support and especially placed emphasis on the importance of definitions—an argument that was made by every Opposition Member who spoke.
We then began what I can only describe as a parliamentary filibuster. Conservative Members followed each other and spoke to the briefing notes. The hon. Member for Ribble Valley (Mr. Evans) condemned high-profile complaints and then treated the House to an example of a high-profile complaint. The hon. Member for Croydon, North-East (Mr. Congdon) read the Library note adequately, but he was rehearsing what the hon. Member for Edgbaston had said earlier.
The hon. Member for Beckenham (Mr. Merchant) got his parliamentary revenge on me and my former colleague, the late Harry Cowans, for having kept him up late at night in 1984 on the Rates Bill. He clearly harbours a grudge and undoubtedly remembers the inadequate whipping by the Government during the passage of that Bill. He was followed by the hon. Member for Castle Point (Dr. Spink), whom I must congratulate on having managed to find and then read to the House the one bit of the Library briefing note that other Conservative Members had not yet read. At that stage I found myself thinking, "Why me?"
The House will recall that last week I attended the passage of a private Bill when I represented, on my own, the parliamentary Labour party as my hon. Friend the Member for Hackney, South and Shoreditch (Mr. Sedgemore) delivered a two and a half hour defence of Bart's hospital. At least he did it with elegance and enthusiasm. Attending parts of today's debate was not like watching paint dry but like listening to it. Even the Minister's parliamentary private secretary fell to reading Scallywag—as far as I could see from here, it was the latest edition. Presumably he was checking to see if the Minister for Health appeared in it. I do not know whether that is part of his parliamentary duties—[Interruption.] The Minister obviously does not appear in it.
The hon. Member for Hexham (Mr. Atkinson) raised a perfectly good point about accountability. The General Medical Council is not responsible to the Secretary of State for Health; it is responsible directly to the Privy Council. Parliamentarians on both sides of the House are right to be especially vigilant when there is a suggestion that the royal prerogative is to be used rather than a decision of the House.
Every point having been made umpteen times, the hon. Member for Salisbury (Mr. Key) returned to an earlier theme. He would not have known that he was returning to an earlier theme as he entered the debate pretty late and apologised for doing so. He asked what was meant by professional misconduct. The discussion about definitions is at the heart of today's debate. The key question is how should a profession be regulated. I say as gently as I can to the House that it must involve professionals, even if only professional advice. The laity are also important—a subject that we shall want to examine in Committee—because they are there to represent the public interest.
The debate's second theme involved the meaning of the key terms in the Bill. As my hon. Friend the Member for Newcastle upon Tyne, Central asked, how is "serious" to be defined and why is the word "serious" necessary? My hon. Friend the Member for Strathkelvin and Bearsden made exactly the same point around the use of the word "competence". We were asked whether a single incident would be sufficient under the new procedures or whether


a doctor's performance over time was to measured under the new procedures. I understood the Minister to say that there were circumstances in which a single incident could of itself bring the new procedures into play. We shall wait to see the sort of cases that will emerge. It is important that we understand that a single incident could trigger off the procedures.
Will the Minister tell us whether the Government intend to legislate for the other professions? In my opening remarks I listed the phrases that pertain to disciplinary actions involving the other national health service professions, and a response from the Minister tonight would be helpful.
I conclude by making a plea around the procedural point. It would reflect credit on the House if we dealt with this issue, on which there is no division on principle between us, in a non-adversarial way in a Special Standing Committee, thus enabling people to give evidence to us so that we could make our decisions on the basis of it. It is a suitable Bill for that procedure, and I make the Minister this pledge: if he adopts that procedure, we shall do everything that we can to facilitate it and make it work as it should rather than to frustrate it or use it in a partisan way.

The Minister for Health (Mr. Gerald Malone): I must first refute the scandalous suggestion made by the hon. Member for Newcastle upon Tyne, East (Mr. Brown) that the contributions made by Conservative Members were anything other than extremely constructive. I listened to all of them with care. My hon. Friends, like the hon. Gentleman's colleagues and the hon. Member for Argyll and Bute (Mrs. Michie), contributed to an excellent debate on a complex subject and each raised a number of novel points, to which I shall respond.
I must also point out that, had it not been for my colleagues carrying the debate when there were no Opposition Members here to do so, the hon. Member for Newham, South (Mr. Spearing) who, with his usual courtesy, had alerted my colleagues and I to the fact that he was hoping to speak but could not be here until late, would have been thwarted, returning to the Chamber only to find the debate had finished. I, for one, am pleased that he was able to make his valuable contribution.

Mr. Nicholas Brown: I must apologise. I had not realised that the governing party was deliberately keeping the debate going so that my hon. Friend the Member for Newham, South could contribute. I apologise to the Minister and thank him for filibustering in a debate on the Government's own legislation.

Mr. Malone: It was a happy and slightly unforeseen consequence of my hon. Friends' enthusiasm.
I am extremely pleased to be able to thank the hon. Member for Newcastle upon Tyne, East for his remarks in support of an important Bill and for saying that, ultimately, the Bill will pass through Committee with reasonable dispatch, subject to discussion of the very many issues that will be raised in Committee and to which hon. Members of all parties have alluded. I hope that the circulation of the notes on clauses will assist detailed discussion of the Bill later.
Hon. Members raised a wide range of concerns about the responsibilities of the General Medical Council as well as their views on the Bill. I shall try to deal in detail

with as many as possible and comment on some aspects of the Bill that have not been raised in great detail—and there are some, although the hon. Member for Newcastle upon Tyne, East may not think so.
When my right hon. Friend the Secretary of State opened the debate, she mentioned the importance that the Government attach to the GMC's new procedure. I am happy to wind up the debate, but I must make it clear that the Under-Secretary of State for Health, my hon. Friend the Member for Bolton, West (Mr. Sackville), who was here at the beginning of the debate but was unable to remain until the end because he had commitments elsewhere, will take the Bill through its remaining stages.
Several hon. Members mentioned the possibility of a Special Standing Committee. The Government believe that there has already been thorough consultation on the Bill's subject matter. The GMC has issued two consultation documents and we believe that little would be gained by using the Special Standing Committee procedure in this case. I listened with some care to the hon. Members for Newham, South and for Newcastle upon Tyne, East on this subject, but, following the consultation process, it is clear that the Bill is supported by a wide range of professional groups and patient groups which comprise the type of people who would come before such a Committee. They have made their position clear. The remedial approach is supported by professionals; it is preferable to putting doctors through adversarial proceedings of conduct hearings, which are regarded as punitive and would require criminal standards of proof.
As those important matters have been extremely well aired by the GMC in the two consultation documents, it is the Government's view that a Special Standing Committee would not be entirely appropriate as the purpose of such a Committee is to raise novel issues that were not canvassed before the Bill reached Second Reading.

Mr. Spearing: In the bipartisan atmosphere, I thank Conservative Members for bringing to the debate facts and matters that have been transferred from another part of the building and that otherwise might not have been recorded in Hansard. Does the Minister agree that nothing will change the Standing Committee stage? All he is saying is that we are not to have the preliminary of up to three mornings. He says that it is not worth it. How does he know? How can he prejudge what extra might emerge in those Select Committee hearings?

Mr. Malone: I am not trying to prejudge that. There has been a substantial consultation process that is adequate for the Bill to proceed.

Mr. Galbraith: Will the Minister give way?

Mr. Malone: No. I have a substantial number of points to address in the remaining 15 minutes, not least some of those raised by the hon. Gentleman.
I cannot give the undertaking that the hon. Gentleman Newcastle upon Tyne, East sought. I turn directly to a number of points that he raised. First, he asked about the role of the screener. I repeat that the screener, who will be a medical member of the GMC, will decide whether there is sufficient evidence to support an allegation of seriously deficient performance. He will examine the evidence submitted to him and, if necessary, will seek additional information.
A complaint can be dismissed only with the concurrence of a lay screener. The Government believe that that will afford protection to complainants in that their complaints cannot be dismissed by one individual alone. That provides substantial reassurance.
The hon. Gentleman also asked whether retraining is the answer if a doctor is persistently poor. A doctor must be given a chance to mend his or her ways. The Bill is not punitive, but designed to bring people back into line.
The assessment process may be the first time that a doctor is brought to the point of accepting that his or her performance is poor. Training may not be the sole answer. That point was raised by the hon. Member for Newham, South, who said that it might be a fairly complex matter. There may also be a need for counselling or for a period working under the guidance of another doctor. If a doctor does not improve, or performance is found to be so poor that there is a danger to the public, the matter can be referred immediately to the committee on professional performance, which can impose sanctions, conditions or suspension.
The hon. Member for Newcastle upon Tyne, East also asked about the reinstatement of doctors who had voluntarily removed their names from the register, consequential to the powers in clause 2. If a doctor subsequently applies to have his or her name reinstated,, the application for reinstatement will be considered by the appropriate committee of the GMC.
The hon. Gentleman also raised the important issue of meetings in private. Rules will provide that the assessment referral committee will meet in private. One of the reasons for that is that the proceedings before that committee are preliminary in nature and should be held in private, as are the preliminary proceedings committee of the GMC, which considers conduct matters.
I am sure that the hon. Gentleman will have recognised that the Bill provides that rules will be made determining whether proceedings before the committee on professional performance, which is the main committee in respect of the legislation, will be in public or private. Initially, the GMC has taken the view that it would like them to be in private, but it will keep the matter under review. In any event, the doctor who is the subject of the proceedings will be able to demand that the proceedings be public if that is what he or she wishes.
The hon. Gentleman also mentioned other professional bodies and inconsistent powers, to which he asked me to refer specifically in my winding-up speech. He is correct in his summary of the powers of other health regulatory bodies. They differ to some extent and none parallels exactly the GMC's new performance procedures. The Bill results from a medical profession initiative and we would be very interested in proposals for change that any other professional bodies may choose to develop and bring forward. However, such proposals must be developed as carefully as the GMC's measures and should include public consultation, which was a very important element of the GMC's preparation for the Bill. At present, we have no plans to introduce legislation, although we would be prepared to consider the matter if other professional bodies put such proposals before us.
I now turn to the excellent speech by my hon. Friend the Member for Birmingham, Edgbaston (Dame J. Knight), who raised a number of points that I shall address

directly. She asked, rather pertinently, what clause 1(9) of the Bill means. How will people—for example, employers—know that a doctor has been suspended? That is an important question.

Dame Elaine Kellett-Bowman: Absolutely.

Mr. Malone: My hon. Friend will doubtless be glad to hear—as she endorses its importance from a sedentary position—that, if a doctor is suspended, his or her name will still appear on the register simply because the name has not been erased. The registrar of the GMC will ensure that a note appears against the doctor's name to the effect that suspension has taken place or that conditions have been imposed on registration. Anyone who makes a search of the register—as employers should do—will discover what the position is.
Access to the register will also be improved. The GMC is actively exploring ways to make the register more accessible in its up-to-date form, which will be important as matters proceed fairly quickly. For example, it will be made available on the Internet—how fashionable can one get, Mr. Deputy Speaker?—or on CD-ROM. I assure my hon. Friend that the register is checked regularly by employers—12,000 last August—to ensure its effectiveness. It is an extremely active register and I hope that my hon. Friend is reassured by my comments.
A number of hon. Members raised the issue of seriously deficient performance. There is no clear definition beyond that in the Bill which, as I said to one hon. Gentleman, is not unusual when drafting legislation of this sort. However, I shall explain what is intended for the future. The GMC will issue guidance setting out the standards of professional performance that will be expected of doctors. It currently gives similar guidance on professional conduct and medical ethics in the blue book, as the hon. Member for Newcastle upon Tyne, Central (Mr. Cousins) mentioned. Future definitions will be advanced in the blue book or its equivalent.
Once guidance is available, the GMC will have a clear yardstick against which to measure a doctor's performance and it can therefore decide whether a doctor has been seriously deficient in his conduct. In addition, I am assured that the GMC will publish the details of the outcome of performance hearings. As the process develops, a clear body of knowledge will build up to which people can refer in much the same way as a body of case law develops in other areas.
My hon. Friend the Member for Edgbaston also raised the question of overseas doctors. She asked whether language difficulties could count as serious deficiencies in performance. I think that that would be unusual because language ability is tested before registration is granted. However, if communications problems prevented a doctor from competently examining a patient, taking a clinical history and explaining treatment plans and things of that sort, it would constitute a serious deficiency in performance—although I think that such an occurrence would be extremely unlikely.
The hon. Member for Newcastle upon Tyne, Central suggested that the profession was too protected. Under the Bill, anyone may send information to the GMC on a doctor's performance—patients, employers, health authorities or other doctors. I disagree with him that it is a profession that is protecting itself. It is an open procedure and I believe that the rest of the House has recognised it as such.
I congratulate my hon. Friend the Member for Chislehurst (Mr. Sims) on making an extremely important contribution to the debate, as I am sure he will to the Committee. He knows a tremendous amount and is well-versed in these matters. The next time I pass him in the Library and see him behind a pile of books, I will know what he is doing. It was good of him to enlighten us.
The hon. Member for Christchurch (Mrs. Maddock) stated that the ultimate sanction of erasure would be available under the Bill. I would like to point out to her that it will not. I would not like her to harbour any illusion on that point. A doctor cannot be erased under these procedures. A doctor can only be suspended or have conditions attached to registration.
My hon. Friend the Member for Wyre Forest (Mr. Coombs) was concerned that the devil is in the detail of the Bill—as it is with so many other pieces of legislation that come before us. The rules that will be made by the GMC are subject to detailed scrutiny by the Privy Council after consultation with Department of Health lawyers.
My hon. Friend the Member for Croydon, North-East (Mr. Congdon), and a number of other hon. Members, asked whether a single act that fell short of serious professional misconduct could be dealt with by the proposed procedures. I said at the time that the answer was yes, and I confirm that. That single act may trigger the action, but the action itself as it goes forward will look at the outcome of the assessment process. Of course, the assessment process will not be based on the single act but will look far more broadly at the track record of the doctor.

Mr. Nicholas Brown: Will the Minister give way?

Mr. Malone: Briefly.

Mr. Brown: Is the Minister adjusting what he said to the House earlier about a single incident?

Mr. Malone: No, I am not. I am saying that the single incident may trigger the procedure, but clearly, by its nature, the assessment process does not look just at the single incident that has been raised. It is expected that an iceberg of problems will be revealed once the assessment committee begins to look at it.
Perhaps the hon. Gentleman will pursue that matter in Committee, as I want to move on to a few other points, particularly that raised by the hon. Member for Strathkelvin and Bearsden (Mr. Galbraith). I think that I am the only hon. Member to pronounce his constituency correctly this evening. Doubtless he will be grateful for that. He raised the point that a doctor may be an incompetent orthopaedic surgeon but be all right to practise in other areas. He asked what could be done about that. The GMC will be able to place specific conditions on a doctor's registration.
The hon. Member for Cannock and Burntwood (Dr. Wright) asked whether the GMC should treat doctors who ignore concerns about a colleague's conduct, health or performance as guilty of serious professional misconduct. The GMC will take action, I can assure him, where it discovers that a doctor is not fulfilling a professional obligation, as outlined in the GMC blue book. So that will indeed happen.
A number of my hon. Friends raised other points later in the debate. I should like in particular to deal with the point raised by my hon. Friend the Member for Castle

Point (Dr. Spink), who asked why there was no reference to the role of the health service commissioner in the Bill. The GMC is, of course, an independent statutory body and is in no way related to the health service commissioner, who can take an interest only in the NHS.
A number of other matters were raised on the Bill. I cannot refer to them now, but doubtless they will be raised in Committee.
The measure has not simply been sought by the GMC but been endorsed by the Government and the Opposition parties. That is quite right. It is an important measure, not just for the medical profession but for patients, who will be reassured by the fact that there is unanimity on both sides of the House about the principle of the Bill, although amendments might well be tabled in Committee. I am delighted to support the measure, to bring it to the House, to make a real improvement, not just for patients but, in the proper context, for the medical profession. It is better to retrain doctors who become less competent, rather than to penalise them. I recommend the Bill to the House.

Question put and agreed to.

Bill read a Second time.

Motion made, and Question put forthwith pursuant to Standing Order No. 61(2),
That the Bill be committed to a Special Standing Committee.—[Mr. Spearing.]

The House divided: Ayes 37, Noes 133.

Division No. 135]
[10.00 pm


AYES


Beckett, Rt Hon Margaret
Loyden, Eddie


Beggs, Roy
Lynne, Ms Liz


Beith, Rt Hon A J
McFall, John


Betts, Clive
Maddock, Diana


Brown, N (N'c'tle upon Tyne E)
Mahon, Alice


Chisholm, Malcolm
Maxton, John


Dalyell, Tam
Michie, Bill (Sheffield Heeley)


Davidson, Ian
Oakes, Rt Hon Gordon


Donohoe, Brian H
Powell, Ray (Ogmore)


Dowd, Jim
Prentice, Bridget (Lew'm E)


Fatchett, Derek
Rendel, David


Foster, Rt Hon Derek
Ross, William (E Londonderry)


Foster, Don (Bath)
Skinner, Dennis



Spearing, Nigel


Galbraith, Sam
Taylor, Matthew (Truro)


Gordon, Mildred
Tipping, Paddy


Gunnel, John
Wright, Dr Tony


Hinchliffe, David



Jones, Barry (Alyn and D'side)
Tellers for the Ayes:


Kirkwood, Archy
Mr. Harry Barnes and


Lewis, Terry
Mr. Jim Cousins.




NOES


Aitken, Rt Hon Jonathan
Budgen, Nicholas


Amess, David
Burns, Simon


Arbuthnot, James
Burt, Alistair


Arnold, Jacques (Gravesham)
Butcher, John


Atkins, Robert
Butler, Peter


Atkinson, Peter (Hexham)
Cash, William


Bates, Michael
Churchill, Mr


Biffen, Rt Hon John
Clark, Dr Michael (Rochford)


Booth, Hartley
Congdon, David


Bottomley, Peter (Eltham)
Conway, Derek


Bottomley, Rt Hon Virginia
Coombs, Simon (Swindon)


Bowis, John
Cran, James


Brandreth, Gyles
Davies, Quentin (Stamford)


Brazier, Julian
Day, Stephen


Bright, Sir Graham
Dorrell, Rt Hon Stephen


Brooke, Rt Hon Peter
Douglas-Hamilton, Lord James


Browning, Mrs Angela
Duncan, Alan






Dunn, Bob
Mitchell, Andrew (Gedling)


Evans, David (Welwyn Hatfield)
Monro, Sir Hector


Evans, Nigel (Ribble Valley)
Neubert, Sir Michael


Faber, David
Nicholson, David (Taunton)


Fabricant, Michael
Onslow, Rt Hon Sir Cranley


Fox, Sir Marcus (Shipley)
Paice, James


French, Douglas
Pattie, Rt Hon Sir Geoffrey


Gallie, Phil
Porter, David (Waveney)


Gardiner, Sir George
Powell, William (Corby)


Garnier, Edward
Robathan, Andrew


Goodson-Wickes, Dr Charles
Roberts, Rt Hon Sir Wyn


Gorman, Mrs Teresa
Robertson, Raymond (Ab'd'n S)


Greenway, Harry (Ealing N)
Ryder, Rt Hon Richard


Greenway, John (Ryedale)
Scott, Rt Hon Sir Nicholas


Griffiths, Peter (Portsmouth, N)
Shaw, David (Dover)


Hague, William
Shersby, Michael


Hamilton, Rt Hon Sir Archibald
Sims, Roger


Hargreaves, Andrew
Spicer, Michael (S Worcs)


Haselhurst, Alan
Spink, Dr Robert


Hawksley, Warren
Sproat, Iain


Hayes, Jerry
Stanley, Rt Hon Sir John


Hendry, Charles
Stephen, Michael


Hicks, Robert
Stern, Michael


Howard, Rt Hon Michael
Stewart, Allan


Hunt, Rt Hon David (Wirral W)
Streeter, Gary


Jenkin, Bernard
Sweeny, Walter


Johnson Smith, Sir Geoffrey
Sykes, John



Taylor, Ian (Esher)


Jones, Robert B (W Hertfdshr)
Taylor, John M (Solihull)


Kellett-Bowman, Dame Elaine
Thompson, Patrick (Norwich N)


King, Rt Hon Tom
Thurnham, Peter


Kirkhope, Timothy
Townsend, Cyril D (Bexl'yh'th)


Knapman, Roger
Twinn, Dr Ian


Knight, Mrs Angela (Erewash)
Viggers, Peter


Knight, Greg (Derby N)
Walker, Bill (N Tayside)


Knight, Dame Jill (Bir'm E'st'n)
Waller, Gary


Knox, Sir David
Wardle, Charles (Bexhill)


Kynoch, George (Kincardine)
Waterson, Nigel


Lait, Mrs Jacqui
Watts, John


Lawrence, Sir Ivan
Wells, Bowen


Legg, Barry
Wheeler, Rt Hon Sir John


Lidington, David
Whittingdale, John


Lightbown, David
Willetts, David


Lloyd, Rt Hon Sir Peter (Fareham)
Winterton, Mrs Ann (Congleton)


Luff, Peter
Winterton, Nicholas (Macc'f'ld)


Lyell, Rt Hon Sir Nicholas
Wolfson, Mark


MacKay, Andrew
Wood, Timothy


McLoughlin, Patrick
Yeo, Tim


Malone, Gerald



Mans, Keith
Tellers for the Noes:


Martin, David (Portsmouth S)
Mr. Sydney Chapman and


Merchant, Piers
Dr. Liam Fox.

Question accordingly negatived.

Bill committed to a Standing Committee, pursuant to Standing Order No. 61 (Committal of Bills).

MEDICAL (PROFESSIONAL PERFORMANCE) BILL [Money]

Queen's recommendation having been signified—

Motion made, and Question put forthwith, pursuant to Order [19 December],
That, for the purposes of any Act resulting from the Medical (Professional Performance) Bill, it is expedient to authorise the payment out of money provided by Parliament of any increase attributable to that Act in the sums payable out of money so provided by virtue of any other enactment.—[Mr. Lightbown.]

Question agreed to.

Civil Rights (Disabled Persons) Bill [Money]

Queen's recommendation having been signified—

Motion made, and Question proposed,
That, for the purposes of any Act resulting from the Civil Rights (Disabled Persons) Bill, it is expedient to authorise the payment out of money provided by Parliament of—

(a) any expenditure incurred by a Minister of the Crown under or by virtue of the Act;
(b) any increase attributable to the Act in the sums payable under any other Act out of money so provided.—[Mr. Lightbown.]

Mr. Harry Barnes: I hope that I shall not appear ungrateful for the motion before us. It is required for tomorrow, to allow the Standing Committee that will consider the Civil Rights (Disabled Persons) Bill—my private Member's Bill—to progress.
The Government have been reluctant to table the money resolution. They left it until the last possible moment. Reluctance has been apparent in their whole attitude to the Bill. They tabled the money resolution only because it is part of the custom and practice of the House when someone has been successful in obtaining a Second Reading of a private Member's Bill and it is due to go into Committee. Everything else that they have done has been associated with blocking the Bill. They would be openly blocking the Bill if they did not produce the money resolution that is before us tonight. So they cannot readily and easily be criticised for that. However, they are using other means to hold up the Bill.
On the amendment paper for the Committee's sitting tomorrow, there are already 111 amendments in the name of the Minister for Social Security and Disabled People, who is engaging in a procedure that will make it difficult for the Bill to come out of Committee and appear on the Floor of the House on Friday, which is the last available day when the measure can be dealt with.

Mr. Deputy Speaker (Mr. Michael Morris): Order. I was rather hoping that the hon. Gentleman would come back within the confines of the money resolution—[Interruption.] Order. I hope that the hon. Gentleman is aware of how restrictive the money resolution is—or do I have to give him guidance?

Mr. Barnes: I recognise that we are dealing with a money resolution and that I need to direct my attention to questions about costs. I was just pointing out that the Government have been rather slow in tabling the resolution, which ties in with a host of other approaches to the Bill that they have adopted.
The Government have been misleading about cost. There has not been a cost assessment of the Bill, whereas the cost of the Government's alternative, the Disability Discrimination Bill, has been assessed. Last year, the Civil Rights (Disabled Persons) Bill, which was introduced by my hon. Friend the Member for Kingswood (Mr. Berry), was assessed in a peculiar fashion, which concluded that the Bill would cost £17 billion. That was a massively exaggerated figure, which took account neither of phased provision nor of any benefits to business and the considerable tax take. Such tax take must be assessed in relation to the money that would have to spent on the Bill. It is a matter not only of expenditure but of income.
The Civil Rights (Disabled Persons) Bill and the Americans with Disabilities Act have many similarities. The American Act was introduced not by Clinton, but by Bush and there have been many claims about its revenue-raising potential, which need to be considered alongside the money that it requires. The false furore over the costs of the Bill ignores the real benefits to business and society. The disability debate should not be polarised; it should not be split into different political camps. My Bill is modelled on the American Act, which aimed to bring the walls of exclusion tumbling down.
There were also fears about the cost of such legislation in America, but the American experience shows net social and business benefits, increased access to work, cuts in the cost of dependency and boosts to tax take. Disabled people are also consumers, often with untapped disposable income. The Americans with Disabilities Act—

Mr. Deputy Speaker: Order. The hon. Gentleman really has to confine himself either to access to polling stations or to the disability rights commission and the costs and work of that body. He must confine his speech to those areas. He cannot go into the benefits of VAT, consumer expenditure and so on.

Mr. Barnes: Part IV of the Civil Rights (Disabled Persons) Bill deals with the provision of goods, facilities and services. In America, the Act resulted in some 200,000 new goods and services. For example, a New, Jersey pizza parlour fitted deaf aids, advertised in the deaf community and doubled its profit.

Mr. Deputy Speaker: Order. The hon. Gentleman obviously did not hear me clearly enough. It is no good him just carrying on reading the notes about the American Act that he prepared beforehand. He cannot refer to the American Act on this particular occasion. [Interruption.] Order. I ask him again to refer either to the disability rights commission or to access to polling stations.

Mr. Barnes: I take it that, as the provision of money is linked not merely to access to polling stations and the disability rights commission, I am entitled to mention other matters contained in the Civil Rights (Disabled Persons) Bill, which will require money to be spent. The motion does not state that the expenditure incurred by the Crown will be limited to those two aspects of the Bill. Perhaps I am being told that I can deal with only those two matters because the Disability Discrimination Bill has dealt with the others. Am I allowed to extend the analysis, Mr. Deputy Speaker?

Mr. Deputy Speaker: The scope of the debate is restricted to the financial aspects of the Civil Rights

(Disabled Persons) Bill, not the American Act and what it has done. The debate is purely on this Bill and the two key features of it are the disability rights commission and access to polling stations.

Mr. Barnes: I do not want to challenge your ruling, Mr. Deputy Speaker, with regard to the American legislation. I mentioned it only as an example of how relevant revenues could be raised. I find it surprising, however, that in your ruling you are confining me to discussing the disability rights commission and access to polling stations.

Mr. Deputy Speaker: Order. The hon. Gentleman does not seem to have taken on board the fact that I am confining him to dealing with spending, not raising, money.

Mr. Barnes: Money will need to be spent to provide goods, services and facilities, for example, in transport and education, and on access to housing and premises, as that is provided for in the Bill, as well as on the important work of the disability rights commission and access to polling stations. As polling stations often operate within schools, that will add to provision as regards access to premises and new constructions.
The range of expenditure provided for in the Bill is relevant to the provisions of the money resolution. I am pleased that at last we may be able to adopt the resolution. I welcome it, but I am concerned that it has taken us so long to deal with it.

Mr. Simon Burns: Sit down.

Mr. Barnes: I seek your protection, Mr. Deputy Speaker. I should be allowed to continue as long as I am in order. According to the Order Paper, 45 minutes is allowed for hon. Members to contribute to the debate.
I grant that the important factor is that we make the decision, just as it has been important all along for us to make decisions and progress with the measure. I shall accede to the wishes of the hon. Member for Chelmsford (Mr. Burns) and conclude my remarks, but I hope that the Minister and Conservative Members will be as succinct as I have been on this occasion when we reach further stages of the Bill.

Question put and agreed to.

Resolved,
That, for the purposes of any Act resulting from the Civil Rights (Disabled Persons) Bill, it is expedient to authorise the payment out of money provided by Parliament of—

(a) any expenditure incurred by a Minister of the Crown under or by virtue of the Act;
(b) any increase attributable to the Act in the sums payable under any other Act out of money so provided.

Local Government (Leicestershire)

Motion made, and Question proposed, That this House do now adjourn.—[Mr. Lightbown.]

Mr. Edward Garnier: I am grateful for the opportunity to discuss local government in Leicestershire. On 21 March, my right hon. Friend the Secretary of State for the Environment announced that he was minded to accept the recommendation of the Local Government Commission to alter the present local government arrangements in Leicestershire in favour of a unitary city, a unitary Rutland and a doughnut county council outside the city and Rutland, with the remaining districts and boroughs staying as they are.
Since the last reform of local government in 1974, we have had a county council for Leicestershire which, for administrative purposes, includes Rutland, and nine district, city or borough councils: Leicester city council in the middle of the county; Charnwood borough council in the north; Melton borough council in the north-east; Rutland district council in the east; Harborough district council in the south and the south-east; Oadby and Wigston borough council between rural Harborough and the city's south-eastern boundary; Blaby district council to the south and west of Leicester, separating Harborough, from Hinckley; Bosworth borough council in the south-west and west of the county; and North-West Leicestershire district council.
My constituency takes in the whole of Oadby and Wigston and much the greater part of Harborough district, the smaller part being within the Blaby constituency. I am glad to see my hon. Friend the Member for Blaby (Mr. Robathan) present. Harborough is the largest district within the county in terms of acreage, and borders the city, Melton, Rutland, Blaby and Oadby and Wigston. As the hon. Member for Harborough and a resident of Leicestershire, I take on my own behalf and on behalf of my constituents a profound interest in what is proposed for my county. Those are not matters that affect the interests of only one Member of Parliament, whether he be from the city or the county. They affect us all and, although I represent neither a city seat nor Rutland, on that account I cannot be shut out from expressing my deep concern about what the local government commission proposes for Leicestershire as a whole.
I must get at my right hon. Friend the Secretary of State through the Under-Secretary. To accept the Local Government Commission's recommendations for Leicestershire would be wrong in principle, damage public confidence in local government and lead to greater financial burdens on local taxpayers in the entire county. It would be fundamentally to misunderstand the public mood in Leicestershire, unpopular and, still worse, unwise. The overwhelming majority of Leicestershire's people want no more than to be left alone in terms of local government reform. They neither want nor need upheaval. They expressed that view by taking no interest whatever in the Local Government Commission's activities, or by reacting with puzzlement as it went about its work.
First, I shall deal briefly with Rutland, not because it is unimportant—on the contrary, it is a unique and wonderful county for which I have the greatest affection and admiration and I do not wish to see it harmed in any

way—but because a solution to the difficulties that are bound to present themselves with unitary status, which is bound to attract widespread support throughout Leicestershire, is at hand. The case for recognising Rutland's identity, its long history as a county and its long-time and recently settled residents' strength of feeling for their native and adopted county is well made and can be answered by restoring to Rutland its historic county status. I shall say no more on that matter because my hon. Friend the Member for Rutland and Melton (Mr. Duncan), who is also present this evening, fundamentally disagrees with me on two points. I hope that he will correct me if I get them wrong. First, he thinks that Rutland should be granted unitary status and I respect his view on that. Secondly, he believes that to grant unitary status to Rutland will not affect the remainder of the county of Leicestershire.
On the recommendation to give the city of Leicester unitary status, strangely and, in my view, improperly, the Local Government Commission let it be known in Leicestershire that it intended to recommend a unitary city before it had completed its review. The city of Leicester sits at the centre of the county of Leicestershire and is, in every sense, its core. It is not like Nottingham or Derby, the two cities with which it is most frequently compared, for they are at the edge of their respective counties and have an entirely different economic and geographical relationship with them. Leicester and Leicestershire are two parts of a working whole—40 per cent. of those who work in the city live in the county—and to remove one from the other is to damage both. It is foolish to believe that joint arrangements between the city, the county and the districts is a substitute for the present system—all the more so when one realises that 68 informal and formal joint arrangements will be required to provide the services currently provided by the county council alone.
To enable the city to be viable on its own, it will need to extend its boundaries into the county. Even the Local Government Commission recognised that that would be hugely unpopular in parts of the county closest to the city. No Government can anticipate the results of any future boundary commission, nor guarantee protection from an expanding city in due course. Leicestershire's and Leicester's people wanted no change. Although the commission chose not to offer no change as an express option in its survey forms, that option received more support across the county than any of the commission's three options.
That was noticeably true in Leicester. The commission's own MORI survey showed that only 14 per cent. in the city supported its recommended structure. In a separate exercise, the commission canvassed the opinion of every city household. Despite the city council's campaign for unitary status, just 909 city residents, out of a total population of 285,400, were sufficiently moved to vote for the commission's preferred, now final, recommendation.
Those considerations may be seen as mainly technical ones. At least they were known to the commission and perhaps we can assume that they were simply set aside as the commission settled for unitary authorities in all the larger cities. I suggest that it is time to move away from the belief that those cities are somehow special cases. If the Government's declared policy of no national blueprint is to hold, it can be just as easily and just as properly extended to the cities as to the more rural areas. That


principle becomes all the more important when a second set of considerations is taken into account, and it is vital that it should be.
There are political considerations of which my right hon. Friend the Secretary of State and the Government need urgently to be apprised. Leicester is a politically unstable city, albeit under the permanent control of the Labour party. It is increasingly the victim of a combustible combination of Labour party in-fighting and factional Asian politics. That state of affairs is well known to the national as well as the local press. We have already read press stories about the behaviour of the hon. Member for Leicester, East (Mr. Vaz), who apparently controls the current local leadership and will influence future changes. Press stories have also appeared about the involvement in internal Labour party matters of senior city council officers.
Last autumn, I asked some pertinent parliamentary questions of my hon. Friend the Under-Secretary about the Belgrave residents association. There are many disturbing elements to the story, most now connected to the selection of Labour candidates for the municipal elections in May, which are all currently coming to the boil.
Against that background, the city council has, first, conspicuously failed to deliver the opportunities offered by the city challenge programme. Secondly, it has failed miserably in its bid for a share of the single regeneration budget. Thirdly, it is currently failing to explain how it overspent on the refurbishment of the city's concert hall by £1.6 million and yet still failed to open the hall on time. Cancelled shows have cost the local taxpayer a further £0.33 million. Fourthly, the city council is spending £50,000 of public money to engage lawyers to argue against the professional recommendations of its own officers—officers of the county council and of an adjacent district council—that a gipsy camp on the very edge of the city's boundary should not be built. That proposal offends every planning consideration and every local resident, but according to the city's Labour politicians' dogma it should be built.
Leicester city council's only claim to credit lies in its title of "Environment City", a claim, which, frankly, needs to be taken with a pinch of salt as the gipsy camp debacle shows. It is an authority with no track record to show that it can deliver major projects or major services. Furthermore, Leicester city is a profligate authority. It routinely overspends againstits standard spending assessment—this year by 37 per cent. It must plunder its balances by more than £4 million this year. Its budget requirement per head is far in excess of other cities in the east midlands. The figure for Leicester is £193; for Nottingham, £146 and for Derby, £110. There can surely be no confidence that the city council understands the county services that it would presume to take over, let alone possesses the capability to do so. They are the most important local services, however, where cost-effectiveness is crucial.
The city's submission for unitary status showed an abject failure to grasp and to plan for the scale and complexity of the services. It fails to understand how delegation to schools operates. It has claimed that it will "improve the service", but the money for that is to be kept by the local education authority and not delegated. Secondly, the city's submission fails to recognise, let alone to understand, that almost 90 per cent. of the acute

health facilities of Leicestershire are based within its boundaries. The enormous consequences for hospital social work of the discharge of non-city residents from hospital are thereby ignored.
Thirdly, the city has not seriously considered the implications of disposing of 250,000 tonnes a year of household waste. It has no facilities available in Leicester. Fourthly, it seeks to take over the seven county museum buildings located in the city, but mistakenly believes that a museum service is about buildings rather than collections. It has no conception of the wider range of services that reach out from museums and no respect for the integrity of the collections.
In my view, the question is all too apparent: what sense is there in such people as those who currently control the city council in Leicester being given additional powers and budgets?
I totally refute the suggestion that giving Leicester city unitary status would in some way cut out the canker from the county. It would continue to fester. I understand that the Government's current financial regime, applied within a Leicestershire envelope, would divert additional moneys into the city from the surrounding areas. Council tax payers in those areas would see their bills not only increase to pay for the transitional costs of a unitary city, but simultaneously increase to pay for the existing level of service, at best. Meanwhile, services now provided by the county council to the people of Leicester would be put under the control of people whom I would describe as irresponsible city politicians.
Given the interdependence of the city and the rest of Leicestershire, it is important to recognise the restraint that the county council has brought to bear on the political dogma and excesses of the city council. To remove that restraint, which is what the Local Government Commission's recommendations would mean, would be to the detriment of the governance of both Leicestershire and the city.
There are two further points of great concern to me, which relate to the Leicester, East constituency Labour party and to the hon. Member for Leicester, East. From material that I have received it is now possible to say that charges of interference by the hon. Gentleman in the affairs of Leicester city council, most notably by exercising undue pressure on a former housing director and on a female former councillor, have been made.
It is fair to say that I had a half-hour discussion with the hon. Gentleman yesterday and he has shown me some further papers this evening. Having heard what he told me yesterday and having looked at the papers, I concede that he has provided an explanation—but not, in my view, a complete one. As last autumn he tabled an early-day motion about me containing information that he knew was false, and as I understand that he has telephoned the chief executive of the county council several times to ask him to drop disciplinary charges against a county council employee who is, or was, a prospective candidate for one of the city wards in his constituency, and who was, or may still be, an officer of the Leicester, East constituency Labour party, I have yet to be wholly satisfied that the explanation is a complete one.

Mr. Keith Vaz: May I take this opportunity to deny totally the charges made by the hon. and learned Gentleman, who is known as someone who raises such matters without substantiation? And as he has


given way to me, would he like to comment on a dossier that I have received about him, and a letter signed by a member of the Bosworth constituency party saying that he has asked for this debate because he seeks the nomination for the Bosworth constituency, intending to take advantage of the present position of the hon. Member for Bosworth (Mr. Tredinnick)?
It would be good if the hon. and learned Gentleman gave the House an assurance that he intends to stand in the Harborough constituency in future. I raised that question with him before the debate, so he was aware of what I intended to say. I am glad that he gave me the opportunity to provide him with some information, but that is what I would expect from an honourable and learned Gentleman. Perhaps he would comment on those statements—

Mr. Deputy Speaker (Mr. Geoffrey Lofthouse): Order. Is this an intervention, or has the hon. and learned Member for Harborough (Mr. Garnier) finished?

Mr. Garnier: I intended only to give way, Mr. Deputy Speaker, but as the hon. Member for Leicester, East then began to make a speech, let me tell the House that what he has just said confirms my doubts about the explanation that he gave me last night. That is, I have no—

Mr. Deputy Speaker: Order. We have certainly had enough personalisation now. We shall get on with the debate.

Mr. Garnier: May I simply add, Mr. Deputy Speaker, that everything that the hon. Gentleman has just said is totally false?
The Labour party nationally has consistently failed to clean up the Leicester, East constituency Labour party. It set up an official inquiry in August 1994, but that appears to have run into the sand. The Walworth road line is that accusations of ballot-rigging and membership impropriety—

Mr. Vaz: On a point of order, Mr. Deputy Speaker. This is a debate on local government in Leicestershire. The hon. and learned Member for Harborough is not a member of the Leicester, East or of any other constituency Labour party. There are three other Conservative Members here, and they and I would like to participate in a debate on local government reorganisation. In a debate on local government in Leicestershire it is clearly not in order to describe the inner workings of a constituency Labour party.

Mr. Deputy Speaker: The Chair will decide what is in order and what is not in order but, as the hon. Gentleman says, the debate is about government in Leicestershire and, if we can get to it, it would be most helpful. There is not a lot of time in these Adjournment debates, so would the hon. and learned Gentlemen get down to the debate itself?

Mr. Garnier: It is precisely because of the way that. I employed my arguments earlier that I wish the Government to take carefully the recommendations of the local government review. As I said, accusations of ballot rigging and membership impropriety were fully investigated—

Mr. Vaz: On a point of order, Mr. Deputy Speaker. The hon. and learned Gentleman took your view, Mr. Deputy

Speaker, which is that the debate is about local government in Leicestershire. There are hon. Gentlemen here—

Mr. Deputy Speaker: Order. It is a debate about local government in Leicestershire, and let us now cut the personalities out.

Mr. Garnier: Mr. Deputy Speaker, I am not talking about the hon. Gentleman; I am talking about the unwisdom of allowing unitary status to be given to the city of Leicester, bearing in mind the matters that I am about to discuss.
Walworth road has been informed of those accusations of ballot rigging and membership impropriety, and claims that they were fully investigated in August 1994 and were found to be groundless. Walworth road claims that what is going on is—

Mr. Vaz: On a point of order, Mr. Deputy Speaker. Walworth road is not a unitary council in Leicestershire county council. It is an internal matter. I could raise in Adjournment debates, plenty of internal matters concerning the Market Harborough Conservative Association. The hon. and learned Gentleman is ignoring what you have said.

Mr. Deputy Speaker: Order. I have already said to the hon. Gentleman that I will decide what is in order and what is out of order, but, having said that, I cannot, for the life of me, think what Walworth road has to do with local government in Leicestershire.

Mr. Garnier: I am advancing an argument that Leicester city council is not a responsible organisation and it is, as I said earlier, manned by members of the Leicester East constituency Labour party. I submit that it is not a proper organisation to be given unitary status.

Mr. Andrew Robathan: Does my hon. and learned Friend agree that that is a matter of local government in Leicestershire, which has been aired at length in the best known local newspaper in Leicester, the Leicester Mercury, and that many column inches have been expended on local government in Leicester on the very topic that he mentioned?

Mr. Garnier: My hon. Friend is right. That is a matter of considerable interest in Leicestershire.
I have seen two detailed confidential reports to Labour's national executive committee. They were apparently sent to every member of that committee on 19 February 1995, under cover of a letter signed by 16 senior Leicester Labour politicians. They included, not only the ousted long-serving city council leader, Peter Soulsby, but three former lord mayors of Leicester, the secretary of the Leicester district Labour party, the secretary and chief whip of the Labour group on Leicester city council, the former deputy leader and the vice-chairman of the neighbouring Leicester West constituency Labour party. Despite the seniority of those complainants and the gravity of their allegations, the Labour party shows no signs of taking any action—and that is the organisation that will eventually have control of the city of Leicester. Walworth road shows no sign of taking any action, at least before the 4 May local government elections. The national Labour party appears determined to sweep the practices of that constituency Labour party firmly under the carpet.
A number of the allegations that have been levelled are as follows.

Mr. Vaz: On a point of order, Mr. Deputy Speaker. The hon. Gentleman has totally ignored what you have said from the Chair. This is a debate about local government reorganisation, not about the internal workings of the constituency party.

Mr. Deputy Speaker: I will repeat myself. The Chair will decide what is right and what is wrong. Now can we get down to debate? I have already said that there is only a short period for this type of debate, and one tends to think that they are wasted on some occasions.

Mr. Vaz: Certainly in this case.

Mr. Garnier: As I was saying, some of the allegations that have been levelled are that there have been
block payments for membership by particular people; the withholding of meeting notices to prevent members from voting; the exclusion of members by falsely claiming that they had resigned and the refusal to accept some people's membership without proper reason … the deliberate signing up of Party Members at false addresses to deselect councillors or … otherwise
to
affect the outcome of Party meetings … the use of intimidation"—
for example against Leicester city councillor Mir Juma, who has claimed that it was made clear to him that, if he did not support a specific candidate in the selection, process, the city council funding for the project that he worked for would be threatened.

Mr. Vaz: On a point of order, Mr. Deputy Speaker. This is becoming farcical. A Minister of the Crown is waiting to discuss those important issues, and the hon. Gentleman is mentioning issues concerning councillors who are not a party to the debate and not involved—

Mr. Deputy Speaker: Order. The Chair is now beginning to lose a little patience. There is a fine line between local government and party politics in local government. We are now really stretching a little bit too far. The subject is local government in Leicester.

Mr. Garnier: It is local government in Leicestershire, Mr. Deputy Speaker, which includes the city of Leicester. It is relevant because the Local Government Commission's recommendation, which my right hon. Friend the Secretary of State is minded to accept, is to give unitary status to the city. I suggest that that is unwise for the reasons that I have advanced and am in the process of advancing—[Interruption.]
I urge the House to consider carefully the points that I have made and to ignore the somewhat hysterical interventions of the hon. Member for Leicester, East, who is clearly getting upset. We must work out what is best for Leicestershire and what is best for the people of Leicester. What do people in Leicestershire and the city of Leicester want?
The recommendation is unwise. I ask my hon. Friend the Under-Secretary of State for the Environment to pass on to my right hon. Friend the Secretary of State my view that the recommendation should be postponed so that further consideration can be given to the activities, not only of the Local Government Commission or its recommendations, but to the activities of the people who are most likely—there is no point being prissy about it—to run the city once it is given unitary status.
There have been suggestions that the hon. Member for Leicester, East, who is clearly losing control of himself, has been involved in the overturning of the leadership of the last city council. I shall not dwell on those—all that I ask my hon. Friend the Minister to do is to postpone the period of consideration so that full thought can be given to the wisdom of giving full effect to the recommendations of the local government review.

The Parliamentary Under-Secretary of State for the Environment (Mr. Robert B. Jones): I understand that my hon. and learned Friend the Member for Harborough (Mr. Garnier) has been appointed Queen's counsel today, so it falls to me to congratulate him on his appointment. I should also say how glad I am to see present for the debate my hon. Friends the Members for Rutland and Melton (Mr. Duncan) and for Blaby (Mr. Robathan). I know that they have a great and sincere interest in the subject.
My hon. and learned Friend the Member for Harborough has chosen to have a debate on the important subject of local government, particularly in the city of Leicester which borders his constituency. As he has not felt it appropriate to mention the record of Harborough district council, perhaps I may take the opportunity to pay tribute to the record of that local authority. Its councillors, especially the leader and committee chairmen, work hard and often unthanked. I, for one, am appreciative of what they have done and continue to do for the people of Harborough.
Although those involved in local government have the primary responsibility to ensure that they provide good and cost-effective services to local people, we in central Government also have a responsibility to ensure that the conditions in which local authorities work are right. As part of that responsibility, it is right that the structure of local government should be examined periodically to see if it is still responding to the needs and wishes of local people.
The functions and role of local authorities have always been in a state of flux—more so in recent years—and local people's expectations of them have also changed. That is not to say that local authorities are not providing good services at a reasonable cost, but there is always room for improvement. It was with that in mind that we set up the Local Government Commission in 1992. Its first remit was to review the structure, boundaries and electoral arrangements of the two-tier shire counties. Among other things, the commission was to consider the extent to which a unitary local government structure could better provide convenient and effective local government and meet the identities and interests of local communities. I certainly do not intend to rehearse all the arguments as I believe that they are well known.
I shall now turn specifically to Leicestershire. My right hon. Friend the Secretary of State announced to the House on 21 March his decisions on a number of the Local Government Commission's reports on the structure in the English shire counties. The commission's recommendations, and our decisions on them, have been based on the two criteria that any change must lead to structures which can meet the needs and wishes of local people and must secure effective and convenient local government.
We strongly feel, as did the Local Government Commission, that Leicester city has the right qualities to be an effective unitary authority. Following his announcement on 21 March, my right hon. Friend the Secretary of State has written to Leicester city council confirming that he intends that there should be a unitary authority for Leicester. Some have suggested that our caution over unitary status for Rutland also meant that we were uncertain as to Leicester city's future status. I should like to confirm that that is not the case.
The city of Leicester has a population of 285,000. As such, it is the second largest non-metropolitan district in England and is bigger than all but four London boroughs and the majority of the metropolitan boroughs. Most of the local authorities in the county would support a unitary Leicester, as would many of the local people. The individual responses to the commission's questionnaire and the results of its MORI poll, which I believe is rather more reliable statistically, suggested that there was strong support in the city for the various options involving a unitary Leicester. The MORI poll suggested that 41 per cent. supported a unitary authority while 17 per cent. supported no change.
In addition, Leicester has a tradition of strong civic government and was a county borough. We believe that it has all the right ingredients to make it a successful unitary authority.
The point was made in some representations following the commission's final report, not least those of my hon. and learned Friend the Member for Harborough, that Leicestershire was unique because of the central position of Leicester in the county, geographically, administratively and culturally. We considered those points very carefully before reaching a decision on the structure of the county, but we do not consider that they negate the case for a unitary authority in Leicester.
My hon. and learned Friend suggested other reasons why there should be no structural change in Leicester. However, I believe that in making decisions about the structure of local government in England it is important to draw a distinction between local authorities and the councils and councillors who serve them. We in Government and Parliament can determine the size, shape, structure and services provided by a local authority, as a local authority's powers and duties are derived directly from Parliament, but we should do so with reference to the objective arguments for and against the various options for that particular area, not on the basis of whether we approve or disapprove of the activities of any existing council or group of councillors.
Councillors are, and should be, responsible to their local electorate. It is up to the people in each authority to elect the people who they think will best be able to make the decisions that will directly affect the quality and cost of local services. In this way, it is up to the people in

Leicester city—as, indeed, in any other part of the country—to determine whether their existing councillors are doing a good job.
If there are real concerns about how a local authority is running its affairs, they should be taken to the district auditor or even to the police. Councils need to satisfy district auditors that their functions are carried out in accordance with statutory requirements. This is, and always has been, the main safeguard against irresponsible action. It is also open to local people to draw to the district auditor's attention any evidence of mismanagement, be it financial or otherwise.
We intend, therefore, to put an order to Parliament for its approval, creating a unitary authority for the city. Assuming that the relevant order for Leicester city is approved by Parliament, local people in the city will have the opportunity to select their new councillors. I am sure that, as part of the campaign for those elections, a debate will ensue on the government of the city, past and present. I hope that the debate will be constructive and will aid the cause of good unitary local government for the city.
My hon. and learned Friend suggested that reorganisation would lead to financial resources being diverted into Leicester from the rest of the county because an "envelope" around the county would mean that gains by one authority would have to be paid for by reductions elsewhere in the county. I hope that I can reassure my hon. Friend on this point. The standard spending assessments will be calculated afresh on the basis of the objective indicators for each service that an authority is providing. I cannot predict at this stage what the effects of that recalculation might be, but I can say that there will be no ring fence or envelope surrounding Leicestershire or any other county affected by reorganisation.
I should also like to say a few words about Rutland, which is ably represented by my hon. Friend the Member for Rutland and Melton who speaks with sincerity and knowledge of his constituents. We realise that Rutland has a strong local identity. Indeed, it has a tradition as a separate county. We should like to see that return, but not to the detriment of local services and financial prudence. My Department has asked Rutland council to supply the assurances that we need that a unitary Rutland will be able to make good practical arrangements for the delivery of local services and that, having considered fully the financial implications, the costs can be paid for within the same financial arrangements and constraints as apply to other reorganised authorities. We shall not bring an order before the House until we are satisfied on those points.
In every county that it has been considering, the Local Government Commission's work has created a great deal of interest. Many hon. Members have been very involved in representing the interests of their communities and will continue to be—

The motion having been made after Ten o'clock, and the debate having continued for half an hour, MR. DEPUTY SPEAKER adjourned the House without Question put, pursuant to the Standing Order.

Adjourned accordingly at seven minutes to Eleven o'clock.